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NATIONAL PROVIDER IDENTIFIER (NPI)
Why the National Provider Identifier?
Providers utilize, in many situations, a different provider identification number for every health plan
they are submitting claims to.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary
of Health and Human Services adopt a standard unique identifier for health care providers called the
National Provider Identifier.
The unique Health Identifier for Health Care Providers rule was published January 23, 2004, with an
effective date of May 23, 2008
.
The National Provider Identifier Number
The rule establishes a standard nationally assigned “non intelligent” Provider identifier required to be
used in all electronic health care transactions.
This number will be a 10 digit numeric unique identifier, with an International Standard Organization
(ISO) check digit in the 10
th
position.
This check digit acts the same way your checking account numbers allow banking institutions to verify
your account number.
A Provider will have one number only and the Provider will use this number for every health plan they
submit electronic transactions too. Once a Provider is enumerated with an NPI this number will not
change ever. The NPI remains with the Provider regardless of job or location change.
Who will have responsibility of issuing the NPI?
The National Provider System (Fox Systems, Inc.) has the sole responsibility for issuing all NPI’s to
every provider in the country. This system is a comprehensive, uniform system for identifying and
uniquely enumerating health care providers at the national level. The Department of Health and Human
Services (DHHS) will have overall responsibility for oversight and management of the system.
How can a Provider apply for an NPI?
There are several methods that a Provider can apply for a NPI number;
1. Phone: 1-800-465-3203
TTY: 1-800-692-2326
2. E-mail: customerservice@npienumerator.com
3. Mail: NPI Enumerator
P.O. Box 6059
Fargo. ND 58108-6059
