National Provider Identifier

The National Provider Identifier (NPI) is a unique identification number for use in standard healthcare transactions. Healthcare providers and covered entities must use the NPI when transmitting electronic transactions (such as electronic claims and eligibility verification) through the National Plan & Provider Enumeration System.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the use of this identifier. Health plans and healthcare clearinghouses must use the NPI in HIPAA-standard electronic transactions.

NPIs replace other provider identifiers used previously by healthcare providers (and assigned by payers). NPIs will not replace the tax identification number (TIN) on the HIPAA electronic transactions when used for tax reporting. This applies only to the 837 electronic claim.

Even if you do not send electronic transactions from your practice, you might need an NPI to identify yourself in other situations, such as when:

• Another provider wants to refer a patient to you
• A pharmacy needs to bill for drugs you prescribed
• A hospital needs to bill for a patient you treated or admitted
• A lab needs to bill for services you ordered.

You will also need an NPI if you bill Medicare on paper forms.

The Centers for Medicare & Medicaid Services has contracted with the National Plan & Provider Enumeration System to administer the assignment of NPIs and deal with health plans and providers on issues concerning unique identification

To complete the NPI application online or to download a paper copy, please visit https://nppes.cms.hhs.gov/. To request a hardcopy form, call 800-465-3202.

Once you obtain your NPI, click here to download the Hometown Health Provider Change Form (one form per NPI). Fax the completed form to Hometown Health, Attn: Contracting, at 775-982-3751, to update your provider information.