The National Provider Identifier (NPI) is a unique, 10-digit number assigned to covered healthcare providers in the United States, mandated by the Health Insurance Portability and Accountability Act (HIPAA) for all administrative and financial transactions. The NPI acts as a singular identifier for providers across all health plans, including Medicare, Medicaid, and private payers, simplifying the processing of claims and other electronic data exchanges. It is an “intelligence-free” number, meaning the digits do not contain any embedded information about the provider’s location or specialty.
Eligibility Requirements and Provider Types
Any individual or organization that qualifies as a healthcare provider under federal regulation is eligible to obtain an NPI. This requirement applies to those who conduct HIPAA standard transactions, such as submitting claims electronically, or who bill Medicare. Since the NPI is a permanent identifier, licensed and unlicensed residents are also encouraged to apply early in their clinical responsibilities.
The system distinguishes between two primary types of providers. A Type 1 NPI is for individual healthcare providers (e.g., physicians, nurses, sole proprietors), who are eligible for only one NPI number throughout their career. A Type 2 NPI is assigned to organizational providers, such as hospitals, clinics, and group practices.
Organizational providers may need multiple Type 2 NPIs if they have multiple practice locations that function as separate entities or bill under different Tax Identification Numbers (TINs). An individual who is incorporated may also need both a Type 1 NPI for themselves and a Type 2 NPI for their corporate entity. The fundamental difference lies in who the NPI identifies: the individual who renders the service (Type 1) or the entity that bills for the service (Type 2).
Essential Information Required for Application
Providers should gather essential data before starting the application. Individual providers (Type 1) must supply their full legal name, date of birth, and Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). Organizational providers (Type 2) must provide their legal business name and Employer Identification Number (EIN).
Both types of applicants must provide a Business Mailing Address and at least one Business Practice Location Address. This information, along with contact details, is essential for communication and public disclosure via the NPI Registry. Additionally, the application requires the specific Healthcare Provider Taxonomy Code, a 10-digit alphanumeric code that identifies the provider’s classification and specialty.
The Taxonomy Code informs payers about the type of services the provider is qualified to deliver. While multiple taxonomy codes can be listed, one must be designated as the primary code.
Step-by-Step Registration Process
The most common way to register for an NPI is through the online National Plan and Provider Enumeration System (NPPES) website. Registration begins by creating an account within the CMS Identity & Access Management (I&A) System to establish a user ID and password. This I&A credential grants the provider secure access to manage their application and NPI record.
Once the I&A account is created, the provider logs into the NPPES website to begin the application. The system prompts the applicant to select the appropriate entity type (Type 1 for an individual or Type 2 for an organization). The application requires the input of all previously gathered identifying and practice information across several sections.
The provider systematically enters their personal or organizational identity details, contact information, and all relevant address data. A dedicated section focuses on the professional details, where the applicant must select and designate their primary Healthcare Provider Taxonomy Code. After completing all required fields, the system provides a review page to verify the accuracy of the entered data.
The process concludes with the provider submitting the application and agreeing to a certification statement. The provider receives a confirmation email, and the NPI number is typically issued within 1 to 5 business days for online submissions. Providers who cannot apply online may use the paper application, Form CMS-10114, which is mailed to the NPI Enumerator and takes approximately 20 business days to process.
Maintaining and Updating Your NPI Record
Covered healthcare providers must maintain the accuracy of their NPI record. Federal regulations require reporting any changes to their information within 30 days of the change taking effect. Maintenance is performed by logging into the NPPES system using the established I&A user ID and password.
Updates are necessary for changes in the practice location, phone number, email address, or the primary Healthcare Provider Taxonomy Code. Once logged in, the provider selects the option to manage their NPI record and navigates to the specific fields requiring modification. While certain required information cannot be deleted, it must be changed or updated to reflect current details.
Providers can also use the public NPI Registry search tool to verify that the publicly disclosable information in their record is correct. If a provider ceases to practice or an organization dissolves, the NPI can be deactivated by logging into the NPPES system and selecting the deactivation option, providing a reason for the request.