Understanding NPI for Nurse Practitioners & How to Obtain

As a nurse practitioner, one of the first things you need to do is obtain a National Provider Identifier (NPI). This has replaced the Unique Physician Identification Number (UPIN), and this transition was made under HIPAA in 1996. If you are wondering whether you need to obtain an NPI number, why it’s important and how you can go about doing so, we will answer all your questions in this article!

What is a Nurse Practitioner NPI Number?

A nurse practitioner NPI number is a unique 10-digit code that is issued to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). This applies to healthcare providers that are covered by HIPAA, as opposed to a UPIN that is required for commercial healthcare establishments. An NPI number allows the CMS to identify healthcare providers that are covered under Medicare and Medicaid as well as a few other purposes.

Once you have established that you need to obtain an NPI number, you may be wondering why it’s important and how you can go about obtaining one, which you can find out more about in this guide.

The Importance of Nurse Practitioner NPI Numbers

It is important for you to obtain a NPI number as soon as possible. Its main purpose is to enable health information to be sent quickly and efficiently via electronic means. This will improve both administrative processes and financial transactions. HIPAA-standard transactions allow information to be exchanged for the purpose of putting in claims, coordinating benefits and premium payments, as well as determining eligibility and enrollment.

As long as you are completing a HIPAA-standard transaction, your NPI must be used instead of any other provider identity when completing transactions. This includes when billing the insurance providers of your patients and submitting claims.

Is Your Nurse Practitioner NPI Number Confidential?

Just like your Social Security Number, keep in mind that your NPI number is not confidential. It will be publicly available on the National Plan and Provider Enumeration System (NPPES) page. This means that you will have to take steps to protect it from identity theft, as it is not unknown for cyberattacks to occur, especially when it comes to committing Medicare and Medicaid fraud.

Some ways you can protect your NPI number include:

  • Only reveal your NPI number to limited parties. Make sure to share it with authorized parties exclusively for valid reasons.
  • Monitor reimbursements and claims to ensure that the billed services match the income of your practice.
  • Take the time to update your enrolment information when anything changes whether that is your practice location or employer.

How to Get an NPI Number for Nurse Practitioners

The process of signing up for an NPI number can be done online on CMS’s website. You will first need to navigate to the National Plan and Provider Enumeration System (NPPES) page. Otherwise, you can complete a physical application form and mail it to the NPI Enumerator address.

  • Applying for an NPI as an individual (sole proprietorships)

If you are applying as an individual, you will need to create a username and password under the Identity & Access (I&A) management system and log in using these credentials. You will need to apply under Type I, and instead of your Employer Identification Number, you will need to submit your Social Security Number.

  • Applying for an NPI as a group (incorporated Practices)

Your application will be submitted under Type II. Even if you are a S corporation that represents only one practitioner, you are still eligible to apply under type II.

Understanding the Nurse Practitioner NPI Application Process

The process of applying for an NPI is relatively straightforward. Whether you opt to complete the process electronically or by sending in a hard copy of an application form, you can expect your application to be processed within 20 days at the most. You can also opt to authorize an Electronic File Interchange Organization (EFIO) to send in your application data on your behalf.

Will Your NPI Number be Affected if You Quit a Practice or Change Your Personal Information?

As your NPI number does not cover personal information about you, it will not change even if you change your name, address or any other personal details. What your NPI number will cover is your provider type, specialization as well as the state in which you practice. It is important to take note that if any of your enrolled information changes, such as the address of your practice, you have 30 days within which to notify NPPES and get it updated.

An NPI number is meant to be attached to you throughout your career, even if you change practices. This means that if you have a Type I NPI number, you can use it at multiple locations. There are very rare circumstances under which you will need to obtain an entirely new NPI, such as if it has been used fraudulently by a third party.

Looking for a Supporting Physician as a Nurse Practitioner?

As a nurse practitioner, there are many things that need to be in place before you can start practicing. This includes obtaining your NPI number. It may also include finding a collaborating physician who enjoys working with you. If you are having trouble finding a physician who is able and willing to work with you, you have come to the right place at Collaborating Docs.

Our promise to you is that we will match you with a collaborating physician within 14 days or less, no matter which state you are practicing in. To top that off, we will draft the collaborative agreement on your behalf and make sure that your collaborating relationship is in compliance with state-specific requirements. We welcome you to check out our client testimonials and request a free Zoom Call for a personalized quote to get started with the process now!

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