HIPAA National Provider Identifier (NPI) Rule
(45 CFR Part 162)

HIPAA anticipates the adoption of national identifiers for employers, providers, health plans, and patients. The employer identifier is the IRS employer identification Number (EIN); compliance with that rule was July 31, 2004. The health plan identifier and the individual patient identifier have not yet been adopted.

The final rule for implementing the national provider identifier (NPI) was published on January 23, 2004. The NPI is required on all electronic billing claims no later than May 23, 2007 (May 23, 2008 for small health plans). CMS has issued guidance to providers on how to request an NPI. Go to www.cms.hhs.gov/hipaa/hipaa2/npi_provider.asp. Physician practices may also contact the enumerator (the contractor charged by CMS with administering the NPI application process) at (800) 465-3203 or go to https://nppes.cms.hhs.gov.

Medical practices can learn about Medicare processes for transitioning to the NPI by going to the CMS MedLearn Matter site: http://new.cms.hhs.gov/MedlearnMattersArticles/2005MMA/List.asp#TopOfPage
and searching for SE0528.