Every provider in this country has a National Provider Identifier (NPI). This is a unique identification number for covered health care providers. According to CMS, it was created to improve the efficiency and effectiveness of electronic transmission of health information, to assist with the efficient coordination of benefits transactions, and to keep electronic transmission of HIPAA. You must have an NPI number if you want to practice in this country, regardless if you accept cash or insurance.
Why do you need an NPI number?
A medical provider cannot issue prescriptions, order labs, acquire supplies, etc. without an NPI number. While most practicing NPs likely have an NPI number, you can file for one here.
If you are an insurance-accepting provider, you are required to have an NPI number in order to bill Medicare, Medicaid, and private payers. When you start a practice, you will also need this NPI to order supplies and medications. It can be extremely useful to memorize your NPI number for streamlined administrative tasks.
Do I need to have a separate NPI for my business/practice?
This depends on whether you are billing insurance. If so, you need a group NPI number. This NPI will be used to credential your practice. If you are a cash practice, you are not required to have an NPI number for your practice. When you operate a cash practice, you will only be utilizing your NPI to issue prescriptions, order medications, etc.
What about NPs employed by an independent practice?
Medicare, Medicaid, and private payers need to credential your entity. When you are employed with a practice, they will generally credential you personally while you function under their practice NPI. When you start a practice, you will still be credentialed individually, but your practice will need to be credentialed as well, and this generally requires a group NPI number. The credentialing process can take three to six months.
An NPI is your medical provider social security number. If you want to practice in this country, you need one. If you want to operate a cash or insurance practice, you still need a personal one. If you are operating a cash practice, it is unnecessary to have a group NPI. If you are operating an insurance-based practice, you must obtain a separate group NPI. Additionally, you can only have one personal NPI, so do not obtain more than one. Now get out there and start that side practice!
46 Responses
Hello! I have an NPI number as a private IBCLC. I applied for it in New York where I was practicing. I recently moved to Florida. Since it’s a national provider number does it cover me while practicing in Florida?
Thanks Mary Marzinek
Yes, the NPI follows you.
Hello,
I am a new graduate and recently pass the ANCC exam. I am looking for employment now. Can I apply and receive a NPI without having a job offer?
Absolutely, you do not need a job to have an NPI!
Thank you so much for sharing your knowledge. It has been a year since I graduated and passed my AANC exams with little luck in landing my dream job or any job for that matter. However, I have been reading your informative blogs and feel inspired as well as compelled to try to to this side hustle for myself since no one else will employ me. I recently applied for and received my NPI number but I had to use my home address since I did not have an office, group or business address to use. Is this okay to do and if not how can I change it in the future? Also what do you suggest for the business address with telemedicine? Do I need an address if the LLC will be based in WY?
Hi Divia,
Thank you for reading and following! First off, change the NPI address immediately. You do not want patients looking up your NPI and seeing where you live. You should be able to do this through the same portal you registered for the NPI, it is straightforward. Second, use a virtual address for your telemedicine practice. If you utilize the service I mentioned in the step by step guide, they will provide you an address! Just use that one, that is what I do!
HIPAA provisions require all healthcare providers to have a National Provider Identifier. This number is a unique, government-issued, standard identification number for individual healthcare providers.
Yep, it is a providers social security number.
When applying for my NPI number, what address should I use for the buisness portion if I am unemployed?
I would advise using a virtual address that is registered under your LLC.
So, do we need a group NPI to order labs through Access Labs with the discount code you have provided us? Also, is there any modification that needs to be made to our personal NPI number to indicate that we have our own practice and will be prescribing medications, etc from this practice (cash practice)?
You do not need a group NPI for the Access Labs discounts. There are no other modifications necessary for your NPI if you have your own practice. There is literally nothing you need to do with your NPI. It is just “there.”
I am an APRN, however my state is a collaborative state so I will be using a medical director instead of a collaborating agreement. Can I order medications/vitamins from pharmacies using my NPI number or should I use my medical directors NPI. I will be working under my RN license at my infusion center.
That doesn’t matter. You can order them under your NPI or theirs. That will just be a pharmacy and medical supplier specific requirement but I do not see why most of them would not let you order under your personal NPI
Hi, I recently graduated and passed my NP boards. While I am waiting for my license, am I allowed to use my ANCC confirmation number to apply for NPI? Or should I wait until my license is approved? Thanks!
Wait until you have your license.
Hi Justin,
Ty for all the info. I am trying to apply for our group NPI for our house calls and telemedicine practice that we are planning to provide primary care for. I guess I am confused about what taxonomy we should classify under. Should we just put family medicine or put nurse practitioner-primary care? This is a little confusing. Ty
Just primary care is fine.
Can a nurse practitioner bill insurance (private) for services.
Yes
I am PMHNP-BC and I am starting my own private practice through my LLC in the state of Florida. I will be the only one practicing. Will I still need to get a group NPI? I asked the billing company I am partnering up with and they told me to not get a group NPI for now since that would extend the time it takes to get credential. They stated that my individual NPI would suffice, is this correct?
My understanding is that you need a group NPI to credential the entity with….
I work at a rural access hospital/clinic as an NP and I have a group NPI however I am opening my own medical spa through an LLC, do I need to get a personal NPI number? I will not be accepting insurance if that makes a difference. Thank you
You would just use your personal NPI for your cash practice
My organization asked me for my NPI login and password so that I could be credentialed under a Type 2 group policy (they need 5 providers to be called a group). Can you tell me exactly what the implications are for sharing my NPI user name and password? What exactly could this group do with my NPI login and password? I’m told it’s to do the credentialing because it’s a lot of work so they’d do it for me.
They can’t do much with it, so don’t worry about it
Should I go ahead and apply for my business NPI if the loan on the clinic I am purchasing is not completed yet? I have a PLLC for my cash esthetics side gig now but have been waiting to apply for the Primary clinic PLLC where I will be accepting insurance. Do you suggest going ahead and proceeding with that as well with the address I am purchasing even though I am not technically practicing there yet?
NPI and loans are not connected at all, so just get the NPI.
And yes, just get started! Don’t wait around for things to “finish”
So I have my NPI, but for employer, it shows the address of a previous employer. Do I add a new employer, listing myself as the employer or do I use my business name as the employer, listing myself as an authorized official. I have the standard LLC, not an S-corp
You are complicating this. The address of your NPI doesnt matter.
Lol, thank you! Just trying to make sure I do it right. The little things like this can drive a person crazy! Thank you for all that you do!
You are welcome. Don’t focus on the little things… it is just noise. Focus on getting patients in the door and treating them. Thats what matters at the end of the day.
Hi, thanks for all the great info. I have a Provider NPI that is being used to bill insurance with a company I work for as a contractor. I formed a new LLC for Cash Based practice with its own NPI. Should I order everything for the Cash Based Practice LLC under their NPI or my Personal NPI?
Yours
I am looking to start a private practice after I graduate as a PMHNP. I am getting the LLC and everything in process now. My question is, since I am going to be doing insurance, can I credential the Group NPI before having any “providers” credentialed? I am a little confused about this process. Or would I be able to credential the group and the personal NPI at the same time once graduated? Looking to save a little time since I have a few months, any insight or help would be great!
You typically will get credentialed personally during the group credentialing process as well.
Is anyone from here familiar with Texas? I plan to run a solo telemedicine practice. However when I was trying to apply for a group NPI through the NPPES website the system did not let me. It stated “a sole proprietorship is not eligible for an organizational NPI” Please advise
You never operate under a sole propietorship… thats just dumb business. Operate from an LLC.
My current job requires me to have an individual NPI as a registered nurse. I’m currently in NP school , do I need to apply for another NPI once I become an NP, as a prescriber .
Yes
I am so confused. I have an LLC and will be credentialing with Headway. But they won’t let me use the NPI 2 to credential as they credential me under their group NPI. Will I still be afforded the asset protection of the LLC when using my NPI 1 and not my LLC’s NPI 2? Otherwise, why would I even need the LLC? Thank you!
Asset protection and NPI have absolutely nothing to do with eachother…. You need the LLC because you need a legal entity to function out of, Headway is simply just billing for you, nothing more
Hello Justin,
I’m starting out as a single member LLC providing mobile wound care and primary care, would I need a type 2 NPI? Can I use primary care for taxonomy?
Also, I will be getting a DBA, should I wait until that’s done before applying for the type 2 NPI or I can use the original LLC’d name? TIA
You will need a group NPI if you are accepting insurance. You will need to apply for that under your legal entities name.
I am employed with a large medical practice and have my side private/cash practice. Do I need to update my NPI? Every time I order something it pulls up the group that I currently work for.
No you shouldnt have to update it. My NPI is still tied to a job I had like 10 years ago lol