What is an NPI? The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required that the Secretary of Health and Human Services to adopt a unique health identifier as a standard for all healthcare providers.  On January of 2004, the ten-digit National Provider Identifier (NPI) was established as this identifier.

Who needs and NPI? If you are a individual or organization, covered by HIPAA or if you bill Medicare for your services, you need an NPI.

Types of NPI: In regards to urgent care centers, two types of National Provider Identifiers will be needed:

• Type 1 NPI: Each individual urgent care physician needs a single, unique NPI. This will NPI remain with the provider indefinitely, regardless of employer, state of residence or any other changes in status.
• Type 2 NPI: Incorporated urgent care centers will, also, need an NPI for the corporation.

Deadline: Providers must only use the NPI to identify covered healthcare providers in standard transactions by May 23, 2007.

Individual Provider NPI: Before applying for a individual provider number, individual providers should gather the following information:

• Provider Name
• Provider Gender
• SSN (or ITIN if not eligible for SSN)
• Provider Date of Birth
• State of Birth (if Country of Birth is U.S. )
• Country of Birth
• Mailing Address
• Practice Location Address and Phone Number
• Taxonomy (Provider Type)
• State License Information
• Contact Person Name
• Contact Person Phone Number and Email

Urgent Care Center NPI: Before applying for a provider number for an urgent care center, corporate providers should gather the following information:

• Organization Name
• Organization Mailing Address
• Employer Identification Number (EIN)
• Name of Authorized Official for the Organization
• Phone Number of Authorized Official for the Organization
• Practice Location Address and Phone Number
• Taxonomy (Provider Type)
• State License Information
• Contact Person Name
• Contact Person Phone Number and Email

Providers may apply online for an NPI at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions

After a provider has obtained an NPI, the provider should keep the notification document that NPPES, containing the NPI, as providers may be required to show this document to other healthcare entities.

Note: This information is for coding educational purposes only and should not be used as a clinical guide or as a guide for any specific coding scenario. The user of this information specifically releases Practice Velocity, LLC from any liability or potential liability that might arise as a direct or indirect consequence from reading the information contained on this website.

Some of this information may be expanded from the Coding Q&A column by David Stern, MD, CPC (CEO, Practice Velocity, LLC) published monthly in the Journal of Urgent Care Medicine. Physicians may click on the JUCM icon to the left to order a FREE SUBSCRIPTION to the Journal.

Practice Velocity Urgent Care Solutions is the leading provider of software for charting, coding and billing in urgent care centers in the USA. Click here to request information about Practice Velocity's automated charting and coding solutions for urgent care.