All health care providers (e.g., physicians, suppliers, hospitals, and others) are eligible for NPIs.
Health care providers are individuals or organizations that render health care.
If a health plan (such as an MCO) has to be identified as a healthcare provider in a standard transaction, they would be eligible for an NPI.
However, MCOs will not need to apply for and use an NPI for standard transactions sent to the IHCP.
All health care providers who are HIPAA-covered entities, whether they are individuals or organizations must obtain an NPI to identify themselves in HIPAA standard transactions.
Most individuals and small businesses will have only one NPI.
There are two groups of providers, individuals and organizations.
Individual Providers (The following list is only a sample of individual provider types)
Physicians
Nurses
Dentists
Psychologists
Physical Therapists
Individual providers who are sole proprietors can only obtain one NPI.
An individual provider who works in a group practice or clinic may need to obtain an NPI for himself or herself and a separate NPI for the group practice or clinic.
This is a personal number that remains with the provider for life.
Organization Providers (The following list is only a sample of organization provider types)
Hospitals
Clinics
Nursing homes
Ambulance companies
Group practices
Pharmacies
Organization providers may have the option to obtain more than one NPI.
Some components or 'subparts' of an organization may be eligible to obtain separate NPIs.
Examples of Subparts
Certified separately
Licensed separately by the State
Required by Federal Regulations to have their own billing number
Organization providers may have the option to obtain more than one NPI.
Some components or 'subparts' of an organization may be eligible to obtain separate NPIs.
