A variety of standards, including insurance credentialing and HIPAA, must be considered when becoming a healthcare service provider.

However, ensuring HIPAA compliance is crucial for a smooth reimbursement process, which is why all these steps must be taken. An NPI number is one of these crucial steps.

It is explained that HIPAA is a federal law requiring national standards to ensure that sensitive health information is not disclosed without the patient's consent or knowledge. HHS also issued a HIPAA Privacy Rule that must be implemented to comply with HIPAA requirements. The HIPAA Security Rule also covers a subset of information protected by the Privacy Rule.

NPI numbers are often requested, but how do you get one? Obtaining a National Provider Identifier (NPI) requires credentials in academic medical procedures and training as a trainer. Despite this, you or any healthcare professional do not qualify for an NPI number if you lack formal training or medical compliance knowledge. While performing insurance billing, professionals often encounter significant circumstances where they do not have NPI numbers.

Who Needs An NPI Number?

An NPI is required for any healthcare provider, clearinghouse, or healthcare organization transacting with or using health records covered by HIPPA. Organizations and providers who use medical billing companies to process their claims are included in this category. Individuals, companies, and healthcare agencies transmitting patient health information electronically in connection with a transaction must have an NPI number under HIPPA. It is permanent and cannot be changed once a provider receives their NPI.

How do NPI providers differ?

According to HIPAA's privacy rule, NPI providers fall into two categories:

NPI Type-1: This is for individuals claiming to provide services solely, such as physicians, surgeons, and dentists. NPIs are only available to this type of provider.

NPI Type-2: includes organizations such as a hospital, healthcare system, physician group, assisted living facility, and healthcare provider that has incorporated.

NPI numbers: how do you get them?

The NPPES (National Plan and Provider Enumeration System) is the fastest way for healthcare providers and organizations to get an NPI number. It should take about 20 minutes to complete the application, and you will receive an NPI number within ten days. By using the Identity & Access Management System (I&A), providers can create a username and password and access NPPES.

An NPI number can also be applied through a paper form or by an organization provider. The CMS website provides complete instructions. For accurate medical billing and faster revenue cycle management, NPI numbers are vital. Any health plan under HIPAA regulations will reject any claim submitted without a valid, registered NPI.

Examining an NPI number

Organizations or providers can verify their NPI in several ways. It is the official website for NPI lookups. The website is freely accessible to anyone interested in examining provider identity.

A name or NPI number can be used as a starting point for the verification. As part of the search results, the NPI number appears before the first and last name of the provider; the icon shows the type of NPI, the location where the primary practice is located, the phone number, and the primary taxonomy.


Health is a pillar of success and an essential part of life. However, providing healthcare services and taking care of patients is a profession only specialized people with a certain amount of knowledge in that field can do. HIPAA provides a unique identification code, NPI, for all healthcare and professional medical procedures.

NPIs are 10-digit unique identifiers, similar to barcodes on packages. An NPI can give healthcare service providers credibility to help their patients gain a more comprehensive understanding of health and medications based on the above information. What is the need for an NPI number? Nurses and non-physicians can only obtain NPIs when they complete specific specializations that require it.