NPI (National Provider Identifier)
The NPI is the standard 10-digit identifier for a healthcare provider — the number that says who rendered and who is billing for a service.
Updated
The National Provider Identifier (NPI) is the standard unique health identifier for health care providers: “a 10-position numeric identifier, with a check digit in the 10th position, and no intelligence about the health care provider in the number”. It is obtained from the National Plan and Provider Enumeration System (NPPES), which CMS operates, and it carries no information about the provider — it is an identifier, not a code that means anything. The check digit is why a mistyped NPI is usually caught as invalid rather than silently matched to someone else.
There are two types. A Type 1 NPI identifies an individual provider; a Type 2 identifies an organization. A claim commonly carries more than one — who rendered the service and who is billing for it can be different parties, and the claim has to say so.
In practice
The NPI is a matching key, which is why it produces such blunt failures. A payer uses it to find the provider in its own records: if the NPI on the claim does not match what the payer has under that contract, the claim can be refused on who rendered the service before anything about the care is considered.
Because the NPI is the thread between the claim and the payer's provider record, an NPI problem and a credentialing problem often look identical on a remittance — and they are fixed in completely different places.
Commonly confused with
- Credentialing: The NPI identifies a provider; credentialing is the process of being recognized under a payer's contract. Having an NPI says nothing about whether a payer will pay you.
- Tax ID: The NPI identifies the provider; the tax identification number identifies the entity being paid. A claim can need both, and they answer different questions.