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Understanding Your NPI Number

Urgent Nursing

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, to keep electronic transmission of HIPAA…….. YAWN….. I was falling asleep typing that last sentence, I apologize… In real world terms, it is simply a way to keep track of providers and assign you your own social security number as a health provider. 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? You cannot issue prescriptions without it, order labs, order supplies, etc. It is part of the game, therefore you need one. Most of you reading this already have an NPI number. If you do not, you can file for one here.

If you are an insurance accepting provider, it is required you have an NPI number if you want to bill Medicare, Medicaid, and private payers. When you start a practice, you will also need this NPI to order supplies, medications, etc. So, it is a very important number to have. You probably should memorize it just FYI.

There are 2 main questions nurse practitioners ask in regard to an NPI:

  1. Do I need to have a separate NPI number for my business/practice?
  2. Do I need to have one for a cash practice?

The answer to the first question is, it depends. Will you be 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 though, you do not need to bother with having 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.

Medicare, Medicaid, and private payers need to credential your entity, not just you. 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 personally, but your practice will need to be credentialed as well, and this generally requires a group NPI number (and patience, the credentialing process can take 3-6 months).

The NPI number is a simple concept. It 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. So remember, if you are operating a cash practice, then don’t bother obtaining a group NPI number. If you are operating an insurance practice, you need to obtain a separate group NPI number. Additionally, you can only have one personal NPI, so don’t worry about obtaining more than one. Now get out there and start that side practice!

6 thoughts on “Understanding Your NPI Number

  1. 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

  2. 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?

  3. 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?

    1. 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!

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