NPPES Registration Tutorial

As stated above, individual healthcare providers will register under NPI Registration Type I. These include physicians, dentists, nurses, pharmacists, chiropractors, physical therapists, physician assistants, and sole proprietors.

A sole proprietorship is also considered Type I. A sole proprietorship may get only one NPI. They must report their social security numbers (not EINs). Virtually any healthcare provider could be a considered a sole proprietorship, including most of the examples listed in Type II.  

Other types of healthcare providers will register under NPI Registration Type II. These include organizations that provide health care services or furnish supplies to patients; for example, hospitals, home health agencies, medical practices, HMOs, home health organizations, medical equipment suppliers, and pharmacies.

Solely owned companies that are healthcare providers get an NPI under Type II. The company needs to be registered in their respective state and obtain a tax id/EIN.  If the company is considered a “sub part”, a health care provider will provide the “Legal Business Name” (LBN) and Taxpayer Identification Number (TIN) of the “parent organization” healthcare provider.

All healthcare providers that plan to bill insurance companies must first obtain an NPI number.  Providers that only plan see self-pay patients but will refer patients to other insured providers, also need an NPI.

Obtaining your NPI number is the first step you must complete as a healthcare practitioner to obtain your billing privileges.  Oftentimes, providers will be issued NPI numbers while still in training. 

If you’re not sure if you have one, the first step would be to contact NPPES or view the NPI registry here.  You cannot begin any credentialing without first obtaining an NPI number.

In order to apply for an NPI, you first have an account with Identity and Access Management System (I&A).  One account will now give you the ability to manage PECOS, EHR Incentive Program and NPPES all with one login.  You can create your login for I&A here.

Once you have created your login, you will then have to walk through securing your account with MFA(multi-factor authentication) and then build your profile.  Once your profile has been created and approved, you will then have the ability to register for your NPI number.

Quick reference guide download

Any company with a tax id number is required to have a type II NPI if they plan to bill insurance companies.  This includes medical supply companies, IPAs, pharmacies, hospitals, ASCs, medical practices and home health agencies.  Even if you are the only owner of the organization, you still must obtain a type II NPI.

While your NPI number is issued by CMS, is it not the same as your Medicare number.  The Medicare administrator in your state will issue a unique Medicare provider number that is linked to your NPI number.

If you have forgotten your  Password, first thing you need to do is visit the NPPES Login Page  and click “Forgot Password”.  You will then be directed to a new page where you will enter your userid.  A link will be sent to your registered email with reset instructions.

• If you enter an incorrect User ID and Password combination three times, your User ID will be disabled.
• Please contact the NPI Enumerator at 1-800-465-3203 if your account is disabled.

If you have forgotten your NPPES userid, first thing you need to do is visit the NPPES forgot USERID page and enter your email address or personal identifying information.  If you did not set up your I&A account, it’s likely that someone else’s email is associated with your account.  This will require you to enter your personal identifying information as seen below. 

• Please contact the NPI Enumerator at 1-800-465-3203 or via email at E-mail: [email protected] if your account is disabled.

No, your NPI number and CAQH number are different.  Your NPI number is issued by CMS and is a requirement for all healthcare providers that plan to bill insurance companies.  CAQH is a private organization that commercial payers utilize as a centralized credentialing database.  CAQH numbers are not needed for government payers.

No, your individual NPI will stay with you for as long as you are practicing. The information in your NPI profile can be changed but your actual NPI will remain the same. Your TYPE II NPI follows your entity so if you change your TAX ID, you will need a new organizational NPI.

The short answer is Yes.  CMS is requiring healthcare organizations to link their locations to their entity and for billing purposes, they want each of your locations to have a unique TYPE II NPI.  This isn’t to say that it’s not possibly to credential a location using the primary business’s type II NPI but it does create challenges when it comes to linking payments to the correct location and could result in issues with Medicare in the event of an audit or when completing PECOS applications.  It is best to consult with an expert if you are unsure about how to update your credentialing profile.

After providing the NPIs to healthcare providers, the CMS publishes the parts of the NPI record that have public relevance, such as the provider’s name, specialty (taxonomy) and practice address.  This is why it is so critical to enter accurate and complete information.  Do NOT enter your cell phone number in the telephone section unless you want it shared all over the internet.

The following information will be made publicly available:

• NPI number
• Code
• Name (Legal Business Name)
• Provider Business Mailing Address First Line
• Address
• Telephone Number
• Fax Number
• Provider Business Practice Location Address
• Authorized Official Title or Position: Name: Credential:
• Telephone Number:
• Provider Enumeration Date
• Last Update Date

Medicare enrollment requirements are always changing and one mistake can be detrimental to your organization.  We would love to help with your Medicare revalidations or initial enrollments.  Learn more about our Medicare enrollment services and schedule a free consultation.

PECOS Medicare Enrollment- What you need to know

Submit your Medicare enrollment application with confidence and get it processed fast.

10
Dec

PECOS Issues: Wrong Contact Person & No Primary Location

PECOS has a number of known glitches that we want you to be aware of..... [Read more]

24
Aug

Electronic funds transfer upgrades to the Internet-based PECOS system

Over the last year, the Centers for Medicare & Medicaid Services (CMS) listened to your.... [Read more]

16
Oct