NPI Types

What are the different types of NPI?

There are many different types of NPI in healthcare. The most common are:

1. Provider Enrollment NPI: This is the NPI that is assigned to providers when they enroll in Medicare or Medicaid. It is used to identify the provider in claims and other transactions.

2. Billing NPI: This is the NPI that is used on claims and other transactions to identify the provider who is billing for the services.

3. Pay-to NPI: This is the NPI that is used on claims and other transactions to identify the provider who is being paid for the services.

4. Group NPI: This is the NPI that is assigned to group practices. It is used to identify the group in claims and other transactions.

5. Individual NPI: This is the NPI that is assigned to individual providers. It is used to identify the provider in claims and other transactions.

What is an NPI Type?

An NPI type is a designation used by the Centers for Medicare and Medicaid Services (CMS) to identify the type of provider that a National Provider Identifier (NPI) number is assigned to.

The NPI is a unique 10-digit identification number that is assigned to healthcare providers in the United States. The NPI number is used by healthcare providers and organizations to identify themselves and their billing practices when submitting claims to Medicare and other health insurance programs.

The NPI type designation is used to indicate the specific type of provider that an NPI number is assigned to. There are eight different NPI type designations:

1. Individual provider
2. Group
3. Facility
4. Organization
5. Partnered individual
6. Partnered organization
7. Subpart
8. Unknown

The most common NPI type designation is "Individual provider." This designation is used for providers who are sole proprietors, independent contractors, or employed by a practice or organization. The "Group" designation is used for provider groups, such as physician practices, clinics, or hospitals. The "Facility" designation is used for long-term care facilities, such as nursing homes or assisted living facilities. The "Organization" designation is used for health plans, managed care organizations, or other organizations.

The "Partnered individual" and "Partnered organization" designations are used for providers who are part of a group practice but who do not have their own NPI number. The "Subpart" designation is used for provider subparts, such as a laboratory that is part of a hospital. The "Unknown" designation is used when the NPI type is unknown or not applicable.

The NPI type designation is important for billing and reimbursement purposes. When submitting claims to Medicare or other health insurance programs, providers must include their NPI number and NPI type designation on the claim form. The NPI type designation is used to determine the provider's eligibility for reimbursement and the amount of the reimbursement.

How do I know which NPI Type to use?

There are two types of NPI numbers: individual and organization. Individual NPI numbers are assigned to healthcare providers who are individual people. These providers can be physicians, nurse practitioners, physician assistants, etc. Organization NPI numbers are assigned to organizations such as hospitals, clinics, group practices, etc.

If you are a healthcare provider who is an individual person, you will need to use an individual NPI number. If you are a healthcare provider who is part of an organization, you will need to use an organization NPI number.

You can find out which NPI number you need to use by looking up your NPI number in the National Plan & Provider Enumeration System (NPPES). The NPPES will tell you whether your NPI number is an individual or organization NPI number.

If you are a healthcare provider who is an individual person, you can apply for an NPI number by completing the NPI application form. If you are a healthcare provider who is part of an organization, you can apply for an NPI number by completing the NPI organization application form.

Once you have applied for and been assigned an NPI number, you will need to use that number on all of your healthcare claims and other documentation. Your NPI number will identify you as a healthcare provider to the payers (insurance companies, Medicare, Medicaid, etc.) and will be used in the claims process.

If you are a healthcare provider who is changing your NPI number (for example, if you are changing your name or your practice location), you will need to notify the payers that you are changing your NPI number. You can do this by completing the NPI change form.

If you have any questions about NPI numbers or the NPI application process, you can contact the NPI Enumerator at 1-800-465-3203.