NPI Numbers
I see a lot of questions from therapists asking about NPI numbers. In today’s post I’m going to explain what they are, why you need one, and how to get one.
Most therapists in private practice need one.
An NPI number (National Provider Identifier) is a unique identification number used by health care providers, including therapists. HIPAA requires that all health care providers have an NPI if they are a HIPAA-covered entity. Which essentially means if you are engaging in any HIPAA transactions you need one.
If you are going to bill insurance, you definitely need one.
Insurance companies will require you to have one in order to be a provider. Save yourself some time and get an NPI number before you start the process to get paneled. I’ve devoted an entire chapter in the Master Course as well as a mini course, Billing Insurance 101, to all the ins and outs of billing insurance. If you are planning to accept insurance in your practice, do not skip this crucial information.
You also need to cover yourself if you’re engaging in any transfer of client data via electronic means.
HIPAA requires you to have an NPI number is you are a covered entity. For instance, if you email a client or collateral contact about a client, you have engaged in a HIPAA transaction and you are now a HIPAA-covered entity. So, you need an NPI number.
Look, there’s really no downside to getting an NPI number and it will cover you in the event you don’t realize you are a HIPAA-covered entity, but you actually are by virtue of activities you engage in. I recommend you just go ahead and get one. It’s free to apply and once you get one, it stays with you wherever you go.
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How to apply:
You can apply for one online at https://nppes.cms.hhs.gov/#/. They can be reached at 800-465-3203.
You can also apply via mail. You can get the application on the same website.
If you are working for an agency, your employer can apply for you with your permission.
There are two types of NPI numbers.
Type 1 – This type is for individuals. This is the one you’ll need for private practice; you are applying as a sole proprietor. You apply using your social security number.
Type 2 – This type is for organizations. Examples would be clinics or group practices. If you have any employees, you need to do more research as you probably need to apply for a Type 2 NPI number and may need to get your employees an NPI number as well. If you are opening a clinic, group, or you are planning to employ any therapists under you please do more research on the CMS site regarding this.
For more information check out the CMS article “NPI: What You Need To Know” at CMS What You Need To Know About NPI Numbers. The CMS site has a lot of good resource information regarding NPIs.
To find out more crucial information about the steps you need to take when starting your private practice check out The Master Course, Everything You Need To Know About Private Practice But Didn’t Know To Ask. To get the same information in more affordable, bite size pieces, don’t miss the Mini Courses!
I love helping therapists build successful private practices! For more great information like this to help you build yours, make sure to check out the Master Course and the Mini Courses. I’m here to support you and I want to help you reach your dream!
If you need some individual help with all of this I’m here for you! I offer mentoring services for those who want some personal attention to help them build their successful private practice. Don’t hesitate to reach out to me. You can find out more on the Mentoring page.
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