Glossary / NPI
NPI National Provider IdentifierNPI (National Provider Identifier)
The 10-digit HIPAA identifier every provider carries; the treating practitioner's name or NPI is a required element on the SWO.
The National Provider Identifier (NPI) is a 10-digit, intelligence-free number issued to health care providers through the National Plan and Provider Enumeration System (NPPES). It is a HIPAA Administrative Simplification standard under 45 CFR Part 162, required on standard electronic transactions, and it does not expire or change. Type 1 NPIs identify individual practitioners; Type 2 NPIs identify organizations such as a DME supplier.
In DME documentation the NPI that matters most is the treating practitioner's. 42 CFR 410.38(d) requires the practitioner's name or NPI on the Standard Written Order, and reviewers check that the ordering practitioner is enrolled and eligible to order. An NPI that cannot be matched to an eligible practitioner is a common reason an otherwise complete order fails.
The NPI does not replace Medicare enrollment. A supplier bills under its own NPI but is recognized by the MAC through the PTAN issued at enrollment. NPIs are public, and NPPES is a searchable registry.
Common questions
What is the difference between a Type 1 and a Type 2 NPI?
Type 1 is for an individual, such as the ordering physician. Type 2 is for an organization, such as your supplier company. A physician who owns a practice may have both.
How do I check a prescriber's NPI?
Search the NPPES registry by name or number. AffirmDME validates the ordering practitioner's NPI against NPPES when it reads the order.
Related
See the term in a real checklist.
AffirmDME's readiness checklist names each requirement with its citation, so the vocabulary on this page is what you see on a case. Free to explore in sandbox mode.
Open the sandboxGet an email when the Required PA List changes.
CMS adds codes, the DME MACs revise LCDs, cycle deadlines arrive. We send a short note the week it happens, with what to do about it. No drip campaign. Unsubscribe in one click.
Sources: CMS: National Provider Identifier Standard · CMS MLN: NPI — What You Need to Know · 42 CFR 410.38(d) — Standard Written Order elements . Definitions summarize public Medicare policy and are not legal or billing advice.
More terms
- ADR — Additional Documentation Request
- Prior authorization
- Affirmation and non-affirmation
- UTN — Unique Tracking Number
- SWO — Standard Written Order
- Face-to-face encounter
- DME MAC — Durable Medical Equipment Medicare Administrative Contractor
- Jurisdiction
- PTAN — Provider Transaction Access Number
- MBI — Medicare Beneficiary Identifier
- LCD — Local Coverage Determination
- NCD — National Coverage Determination
- Policy article
- HCPCS — Healthcare Common Procedure Coding System
- Length of need
- Prior authorization exemption
- Competitive bidding
- CMN and DIF — Certificate of Medical Necessity and DME Information Form
- Proof of delivery
- TPE — Targeted Probe and Educate
- Prepayment review