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:
- Do I need to have a separate NPI number for my business/practice?
- 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!
24 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