October 23, 2021

Information about a doctor’s NPI number

A medical NPI number (National Provider Identifier) ​​is a unique, 10-digit number assigned to individual care providers. Providers must use this number with health insurance plans and health information centers for billing purposes, according to the Centers for Medicare & Medicaid Services, the government agency that oversees the NPI. Medical ISFLs help simplify administrative and financial operations related to doctor and hospital visits, diagnostic tests, procedures and treatments.

Purpose

Physician NPI numbers to uniquely identify health care providers without revealing any personal information. ISFLs help identify physicians on hospital bills, prescription information, patient medical records, insurance claims, or any other document transmitted by a health plan, health agency, or processing organization.

History

The Centers for Medicare & Medicaid Services website notes that before Congress mandated a standardized NPI, health care providers had multiple identification numbers for each health or health plan agency, such as Medicare or Medicaid .

In 1996, Congress enacted the Health Insurance Portability and Accountability Act (HIPAA), which provides privacy protection for consumers. The NPI mandate was part of this act, thus standardizing health care operations and protecting provider privacy, as well.

Record

The US Department of Health and Human Services maintains a registry of approved healthcare provider searches, ordered by NPI. The registry offers only the provider’s name, office address, office phone number, primary medical specialty, and provider type, so health plans, hospitals, or state health agencies can verify NPI information for billing purposes.

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