By the Numbers: NPI Types 1 and 2

All health care providers – individuals and organizations – that are covered by HIPAA must obtain a National Provider Identifier (NPI) number. The National Plan and Provider Enumeration System (NPPES) assigns NPIs and updates information as needed. You can read more about NPI numbers in our earlier blog.

A HIPAA-covered entity is one that:

• Is a health care provider conducting certain transactions electronically,
• Is a health care clearinghouse, or
• Is a health plan such as Medicare, Medicaid and commercial plans

Examples of individual HIPAA-covered entity health care providers include physicians, chiropractors, dentists, nurses, pharmacists and physical therapists. 

Organization HIPAA-covered entity health care providers include group practices and clinics, ambulance companies, HMOs, home health agencies, hospitals and laboratories, nursing homes, residential treatment centers, suppliers of durable medical equipment and pharmacies. 

Importantly – whether you are an individual or organization health care provider, if you apply for enrollment in Medicare, your NPI must be included on your application. An enrollment application that is missing an NPI will be rejected.

Two NPI Categories

There are 2 categories of health care providers for the purpose of NPIs:

• Type 1 – Individual
• Type 2 – Organization

Individual health care providers may receive NPIs as “Entity Type 1.” Organizational health care providers are eligible for NPIs as “Entity Type 2.” It doesn’t matter how many employees an organization has – from 1 to thousands.

Some organization health care providers have various components that function rather differently from the parent organization because they supply different types of health care or have separate physical locations. An example is a hospital that offers acute care as well as laboratory and pharmacy services. Any separate component that conducts HIPAA-standard transactions on its own must obtain its own NPI number. 

Please reference the CMS online brochure NPI: What You Need To Know for more details.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.