NPI Eligibility
Health Care Providers
All health care providers (any person or organization that furnishes, bills, or is paid for health care in the normal course of business) are eligible to obtain a national provider identifier. Examples of healthcare providers include:
- Physicians, dentists, nurses, therapists, technicians, and other practitioners
- Hospitals, nursing homes, hospice, and other institutional providers
- Pharmacies and pharmacists
- Durable medical equipment suppliers
- Group practices and health maintenance organizations
Obtaining an NPI does not impose covered entity status on a health care provider.
Covered Health Care Providers
All covered health care providers are required to obtain an NPI. Covered health care providers are defined in the rule as those entities that:
1) meet the definition of health care provider and
2) transmit health information in electronic form on their own behalf, or that use a business associate to transmit health information in electronic form on their behalf, in connection with a transaction for which the Secretary of HHS has adopted a standard.
Atypical or Nontraditional Service Providers
Individuals and organizations that furnish atypical or nontraditional services that are indirectly health care-related, such as taxi, home and vehicle modifications, insect control, habilitation, and respite services may not fall within the definition of health care, and therefore would not be eligible to receive an NPI. Billing services, value-added networks, clearinghouses, and repricers are specifically exempted from NPI eligibility.
Subparts
HIPAA requires the Secretary of HHS to "take into account multiple uses for identifiers and multiple locations and specialty classifications for health care providers." This language indicates that Congress realized that certain health care providers operate at multiple locations and/or provide multiple types of health care services, and intended that the identifier standard take these variations in circumstance into account. The NPI standard accommodates this language by requiring covered health care providers to obtain NPIs for subparts of their organizations that would otherwise meet the tests for being a covered health care provider themselves if they were separate legal entities, and permitting health care providers to obtain NPIs for subparts that do not meet these tests but otherwise qualify for assignment of an NPI. For example, a subpart may qualify for assignment of an NPI based on such factors as the subpart having a location and licensure separate from the organization health care provider of which it is a subpart. Licensure is often indicative of specialty (Healthcare Provider Taxonomy) classification. Thus, the assignment scheme created by this final rule provides flexibility in addressing the varied circumstances of health care providers, as Congress intended.
A "subpart" described in this final rule may differ from a "health care component" described in the Privacy and Security Rules.
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