Whether you’re just beginning your occupational therapy career or are a seasoned veteran, having your NPI number should be a priority.

About NPI

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Standard. An NPI is a unique identification number for covered (see table) health care providers, created to improve the efficiency and effectiveness of electronic transmission of health information. Covered health care providers and all health plans and health care clearinghouses must use NPIs in their administrative and financial transactions.

What is a NPI

An NPI is a 10-digit numeric identifier. It does not carry information about you, such as the State where you practice, your provider type, or your specialization. Your NPI will not change, even if your name, address, taxonomy, or other information changes.

Benefits of an NPI include:

  • Simple electronic transmission of HIPAA standard transactions
  • Standard unique health identifiers for health care providers, health care plans, and employers
  • Efficient coordination of benefit transactions

Who Needs One

All health care providers (that is, physicians, suppliers, hospitals, and others) may obtain an NPI. Health care providers are individuals or organizations that render health care as defined in 45 Code of Federal Regulations (CFR) 160.103.

All health care providers who are HIPAA-covered entities, whether individuals or organizations, must obtain an NPI.

A HIPAA-covered entity is a:

  • Health care provider that conducts certain transactions in electronic form
  • A Health care clearinghouse
  • A Health plan (including commercial plans, Medicare, and Medicaid) Under HIPAA, you are a covered health care provider if you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so.
Occupational therapists would fall under the “individual’s” category (similar to physical therapists).

Settings such as nursing facilities and hospitals may want you to obtain your NPI for administrative purposes.

Applying for an NPI

Link – https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/apply

After confirmation of your data’s receipt, you will receive your NPI via e-mail from Customerservice@NPIEnumerator.com. If you have spam filtering on your e-mail interface, the reply from the NPI Enumerator with your NPI and confirmation message may be intercepted and diverted to a spam folder. Be sure to check this folder regularly after submitting your data.

The online application is recommended, because is generally quicker and easier to track the status. However, if you prefer to submit a paper application, contact the NPPES customer service hotline at 800.465.3203 to request a paper application form.

This online application takes fewer than 30 minutes once you have assembled the required documents such as your social security number and state license information. If you apply by mail, factor in turnaround time for processing and mailing.

Using NPI

After receiving your NPI number, you may use it in your job application and to update your employer with your unique NPI number.

Thing to Know

Associated information that you enter with your NPI number will be public information. This includes your name, primary practice address, and phone number. This information can be updated, but will be public on the internet. You may want to consider using (with permission) your employer’s address and phone number.

Additional Reading

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/NPI-What-You-Need-To-Know.pdf

OT Dude
Jeff is the lead writer and content creator for OT Dude and covers all things Occupational Therapy. Buy him a coffee: venmo @otdude