The NPI is a unique 10-digit numeric identifier that is used to identify health service providers and organizations. Its use is a requirement of the health insurance Portability and Accountability Act.
Previously, Medicare service providers were identified by a vendor transaction account number or PTAN. In May 2007, this number is changed to the vendor identification number (PIN), and is still used in some Medicare transactions. Both terms are still used occasionally, and both refer to the same number, which is also the same number referred to in the term “inherited number “. These inherited numbers, which were Medicare-specific only, have been replaced by NPI numbers.
Benefits of NPI
- It prevents you from having to preserve and collate identification numbers with the corresponding insurers for transactions
- Allows you to relocate your practice or change specialties without having to apply for new IDs to several insurance companies
- Helps you reduce costs and simplify health care transactions
- contributes to more efficient coordination of benefits
The federal health Insurance Liability and Transferability Act (HIPAA) requires you to obtain a NPI if you file electronic claims, check the status of claims, or access the patient’s benefits and eligibility information online. However, some health plans may apply for NPI for all transactions.
Getting your NPI is simple: When you do, your validity is for life. To get your NPI, log on to the national Plan and Vendor enumeration system and follow the instructions to complete the application.
How to ptan number lookup by npi
- for provider ptan search Opens the search page “National Plan and Provider Enumeration System”, whose address is nppes.cms.hhs.gov
- Click on the link “Search in the NPI registry” ptan search by npi . This will open the home page “Search in the NPI registry”. Both individual providers and organizations that do medical practices have NPI numbers. Click on the link “Particular provider” or “Provider organization” to open the “Search in the NPI registry” page.
- Complete at least one field of the search form. Please note that if you select the suburb/town field, you will have to complete another also. If you’re not sure of the spelling of the search term, you may use the wildcard search. To enter it, complete at least two characters of the term you were looking for, followed by an asterisk (*). For example, if Complete “The provider’s last name” field with “Sm *”, you will find those providers whose last name begins with “Sm”, such as “Smith” and “Smythe”.
- Click on the “search” button and the page will expose the results medicare provider ptan search . Click the NPI number of any of them to see the information of that provider ptan lookup by npi number .
Who needs a NPI?
All health care providers who transmit health information related to a standard electronic transaction should get a NPI. The federal health Insurance Liability and Transferability Act (HIPAA) requires a NPI to perform electronic transactions.
All independent providers in the health care area (including dentists) and health care organizations, such as clinics and joint practices, are eligible to obtain a NPI.
If you answer affirmatively to the following questions, you are within what is considered a “covered entity” according to the NPI rule and it is obligatory to obtain the NPI according to the federal law.
Do you file electronic claims?
Do you use an information exchange center?
Do you send accompanying documents with claims in electronic form?
Do you use the Internet to obtain information about benefits and eligibility or check the status of claims?
What is the NPI most suitable for you?
There are two types of NPI: Type 1, for independent providers of the health care area such as dentists and hygienists. Type 2 for companies registered as joint and clinical practices.
Providers (Type 1) who have to obtain a NPI include physicians, non-physician health professionals, other suppliers and certified providers such as institutions, home health agencies and nursing homes. Specialized. Each doctor or health professional will receive a NPI.
Organizations (type 2 vendors) can get a NPI for each of their subdivisions.
A subdivision can be considered as a center apart from a health services organization, a chain partner or health services organization with individual licensing or certification. To determine if you need to obtain a NPI for your subdivisions, see the information below.
How to apply for NPI
Visit nppes.cms.hhs.gov
Complete the application and follow the instructions to send it over the Internet or post. We do not accept fax shipments.
After the receipt of your request is received, you must receive your NPI by email within one to five business days if you sent the application over the Internet. Processing of requests sent by mail may take up to 20 days.
If you change any data from your NPI (name, address, etc.), you have the responsibility to send an update to the national plan and Supplier enumeration System (NPPES) within 30 days after the change has occurred.
The information provided only has informative purposes and should not be construed as legal advice. We recommend those who obtain their own legal advice around the way NPI affects their practice and professional circumstances.