The National Provider Identifier (NPI) is a unique, 10-digit number assigned to healthcare providers in the United States. This identifier was mandated under the Health Insurance Portability and Accountability Act (HIPAA) to standardize the identification of providers in electronic transactions. The NPI replaces a variety of older, payer-specific identification numbers, simplifying administrative processes across the healthcare system. A Group NPI, specifically, is a type of NPI assigned to an organization or legal entity that provides healthcare services.
Individual vs. Organizational NPIs
A Type 1 NPI is assigned to individual healthcare practitioners, such as physicians, dentists, nurses, and therapists, identifying the person who physically rendered the service. An individual provider maintains this single NPI throughout their career, regardless of changes in employment or practice location.
A Group NPI, also known as a Type 2 NPI, is assigned to organizational healthcare providers, including group practices, hospitals, clinics, nursing facilities, and incorporated entities. This Type 2 NPI identifies the legal business entity itself, which is typically tied to an Employer Identification Number (EIN) for tax purposes. If an individual practitioner incorporates their practice, they will hold both a Type 1 NPI for themselves and a Type 2 NPI for their corporation.
Mandatory Use in Billing and Claims
The primary function of a Group NPI is to serve as the unique identifier for the billing entity during standardized electronic transactions. When a group practice or clinic submits a claim for reimbursement, the Type 2 NPI identifies the organization that is legally receiving the payment.
In a typical claim submission, the Group NPI is placed in the “billing provider” field, while the Type 1 NPI of the specific practitioner who delivered the care is listed as the “rendering provider.” This dual identification is necessary for payers, including Medicare, Medicaid, and private insurers, to accurately process the claim. Failure to use the appropriate NPIs in the correct fields can result in claim denials or significant delays in reimbursement.
Application and Maintenance Process
Organizational providers obtain their Group NPI through the National Plan and Provider Enumeration System (NPPES). The most efficient method for application is submitting the request online through the NPPES portal. This process requires the organization’s legal business name, Tax Identification Number (TIN or EIN), information about an authorized official, and the appropriate healthcare provider taxonomy code describing the service type. NPPES assigns the Type 2 NPI once the application is processed, which typically takes about 10 days for online submissions.
Maintaining the accuracy of the NPI record is an ongoing requirement for all covered entities. Federal regulations require providers to report any changes to the organizational information, such as address updates or changes in ownership, within 30 days to avoid potential claim processing interruptions.