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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

National Provider Identifier (NPI)

What is an NPI?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. As of May 23, 2007, the federal goverment requited states to accept National Provider Identifiers (NPIs) in electronic transactions, including Medicaid transactions, for which federal standards have been written. Full implementation of NPIs took place on May 1, 2009.

The NPI replaced previous health care provider identifiers used in HIPAA standard transactions. Those numbers included Medicare legacy IDs (UPIN, OSCAR, PIN, and National Supplier Clearinghouse or NSC).

NPI Subparts

The NPI is a 10-digit, intelligence-free numeric identifier (10 digit number). Intelligence-free means that the numbers do not carry information about health care providers, such as the state in which they practice or their provider type or specialization. The provider’s NPI will not change and will remain with the provider regardless of job or location changes.

Request an NPI

Individual providers and healthcare provider organizations can obtain NPIs by visiting the National Plan & Provider Enumeration (NPPE) web page

NPI and Address Database

The NPI and Address Database lists the NPI and addresses of active NC Medicaid providers (or providers who have been end-dated within the past 12 months). Use the NPI and Address Database to:

  • Report your NPI to DMA
  • Check if your correct NPI and address is on file or report your NPI to DMA

NPI and Taxonomy

For all claims (except pharmacy) that are submitted electronically, a taxonomy code must be included for the billing provider.

Detailed information about Taxonomy codes can be found in the NCTracks Provider Claims and Billing Assistance Guide (Section 6) as well as at these links:

For placement of data on the 837 transaction, consult the X12 Implementation Guide External link

Atypical Providers

"Atypical" providers are providers who do not provide healthcare services and will not be issued NPI numbers. Atypical providers are individuals or businesses that bill Medicaid for services rendered but do not meet the definition of a healthcare provider according to the NPI FInal Rule 45 CFR 160.103 (for example, non-emergency transportation providers). Atypical providers will use provider identification numbers generated by NCTracks to file their claims.

Medicaid Bulletins about NPI

Frequently asked Questions

The Center for Medicare & Medicaid Services (CMS) has collected hundreds of FAQs covering all aspect of NPI.

CMS Information

 

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