Q: What is an National Provider Identifier (NPI)?
A: A National Provider Identifier (NPI) is a unique, all numeric, 10-digit identifier. The NPI is an intelligence-free identifier, that is, it will not identify any information about the health care provider, such as the providerís specialty, practice location, group affiliation, etc. The NPI is issued in accordance with regulations published in the Federal Register, as part of the Administrative Simplification section of the Health Insurance Portability and Accountability Act (HIPAA) legislation.

Q: Who can obtain an NPI?
A: Health care providers who submit claims or transmit any health information in electronic form in connection with a standard HIPAA transaction must obtain an NPI. Health care providers include physicians, dentists, pharmacists, nurses, health care practitioners, hospitals, laboratories, pharmacies, nursing homes, durable medical equipment suppliers, group practices, health maintenance organizations, and any other health care provider.

Q: How do I obtain an NPI?
A: You may apply for an NPI in one of the following ways.

• You may apply online at https://nppes.cms.hhs.gov for an NPI.
• You may complete a paper application to obtain an NPI and send it to Fox Systems, Inc., the company selected by the Department of Health and Human Services as the NPI Enumerator,. You may obtain a copy of the application at https://nppes.cms.hhs.gov or by calling Fox Systems, Inc. at (800) 465-3203 or TTY (800) 692-2326. Mail the completed application to

Fox Systems, Inc.
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059

• For physicians licensed in Massachusetts, the Board of Registration in Medicine (BORIM) can process a request to obtain an NPI number on your behalf when you complete the BORIM License Renewal Application Form.
• You may allow a third party to submit an application on your behalf, which will require your written authorization. Your hospital, professional association, employer (if employer is a health care provider), or PHO also may apply for an NPI on your behalf with your written authorization.

Q: What is the role of the Board of Registration in Medicine (BORIM) as it pertains to NPIs?
A: BORIM is acting as a clearinghouse for NPIs for physicians licensed in Massachusetts. BORIM can process a request to obtain an NPI number on a physicianís behalf when the physician completes the BORIM License Renewal Form. As part of the license renewal process, the physician must supply an NPI to BORIM, allow BORIM to apply for an NPI on his or her behalf, or supply to BORIM the name of the entity that is applying for the NPI on his or her behalf . BORIM is a designated repository for the NPI number. The designated repository status means that BORIM can process a request for an NPI number on behalf of any Massachusetts physician. There is no charge from BORIM for submitting the NPI application on the physicianís behalf.

Q: What date will I be required to use my NPI?
A: The process to apply for an NPI has already begun. All health care providers must obtain an NPI by May 23, 2007. Health care providers are encouraged to apply for an NPI as early as possible, to avoid any problems with electronic submissions as the May 2007 deadline approaches. Some plans have expressed interest in beginning to use the NPI earlier than May 2007. For example, CMS expects to be able to accept the NPI on Medicare bills as early October 2006. Although most health plans will not be mandated to use the NPI as the sole provider identifier in standard electronic transactions until May 2007, some health plans (including Medicare, Medicaid and Commercial Plans) may initiate systems changes that would necessitate that providers get their NPIs as early as possible.

Q: What numbers will NPI replace?
A: The NPI will replace individual health care provider identifiers, and eventually UPINs. The NPI will not replace such numbers as the Tax ID number or DEA number. The NPI does not guarantee payment by health plans, enroll providers in health plans, nor eliminate health plans credentialing/recredentialing requirements. Once an NPI is obtained, the provider should continue to submit claims that include both the individual health care provider identifiers as well as the NPI until May 2007 for most health plans.

Q: Once I obtain my NPI how should I communicate it to Health New England (HNE)?
A: Once you receive your NPI, send it to Health New England (HNE):

• by e-mail: PEnrollment@HNE.com,
• by fax: (413) 233-2665, or
• by mail to:
  Provider Enrollment
  Health New England
  One Monarch Place
  Springfield, MA 01144-1500.                                                                           

Click here to view MHDC NPI Advisories
Click here to view NPI Frequently Asked Questions (FAQs)
Click here to view NPI Resources