NPI Fact Sheet
For Health Care Providers Who Are Organizations
July 2007
What Is the National Provider Identifier (NPI)?
The National Provider Identifier (NPI) is the standard unique health identifier for health care providers adopted by the Secretary of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). All covered entities under HIPAA are required by regulation to use NPIs to identify health care providers in standard HIPAA transactions.
Who Is Considered an Organization Health Care Provider?
Organization health care providers apply for NPIs as Organizations (Entity Type 2).
Organization (Entity Type 2)
Hospitals, home health agencies, clinics, nursing homes, ambulance companies, and the health care provider corporations formed by individuals are examples of Organization providers. This provider type may obtain one NPI, or may obtain NPIs for some, none, or all of its subparts, if it has subparts (see next section).
How Do a Provider’s Subparts Affect the NPI?
Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations at which health care is furnished; these components and physical locations are not themselves legal entities but are part of the organization health care provider (which is a legal entity). The NPI Final Rule refers to these components and locations as “subparts.” A covered organization provider may decide that its subparts, if it has any, should have their own NPIs. If a subpart conducts any of the HIPAA standard transactions on its own (i.e., separately from its “parent”), it must obtain its own NPI. Subparts are considered organization health care providers and are eligible for NPIs as Entity Type 2 (Organizations). For example, a hospital offers acute care, laboratory, pharmacy, and rehabilitation services. Each of these “units” may require its own NPI because each one sends its own standard transaction(s) to one or more health plans.
Organization health care providers may have a single employee or thousands of employees. For example, an incorporated individual may be the only health care provider who is employed by that organization provider (the corporation that he/she formed).
What Do Covered Organization Health Care Providers Have to Do When Applying For the NPI?
An organization that is a covered provider under HIPAA must:
• Obtain an NPI for itself
• Determine if it has subparts and if those subparts need to have their own NPIs
• If the subparts should have their own NPIs, obtain the NPIs for them or instruct the subparts to obtain their NPIs themselves
• Once NPIs are obtained by the subparts, ensure the subparts comply with NPI Final Rule requirements placed on covered health care providers
