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HIPAA Transactions and Code Sets

Identifiers - NPI

NPI

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services (HHS) adopt a standard unique health identifier for healthcare providers. The National Provider Identifier (NPI) is the result of the mandate. 


On January 23, 2004, HHS published
the Final Rule that adopts the National Provider Identifier (the NPI) as the standard unique health identifier for health care providers. This rule becomes effective 16 months after its publication date (May 23, 2005). Providers need not take any action to apply for NPIs until that date.
The compliance date for all covered entities except small health plans is May 23, 2007; the compliance date for small health plans is May 23, 2008.


When the NPI is implemented, covered entities will use only the NPI to identify providers in all standard transactions. Legacy numbers (e.g., UPIN, Blue Cross and Blue Shield Numbers, CHAMPUS Number, Medicaid Number, etc.) will not be permitted. Providers will no longer have to keep track of multiple numbers to identify themselves in standard transactions with one or more health plans. (The Taxpayer Identifying Number may need to be reported for tax purposes as required by the implementation specifications.)


WHY DO WE NEED AN NPI


CHARACTERISTICS OF THE NPI


CMS FAQ on the NPI


NPI SUBPARTS

NPI ENUMERATION

NPI AND PHARMACY

This page was last updated February 23, 2006 and is maintained by