Healthcare providers may apply for an NPI in one of three ways:
Option 1
Apply through a web-based application process. Visit the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do on the CMS website.
Individual providers must create a username and password through the Identity & Access Management (I&A) System and login to NPPES using that username and password.
Option 2
Complete, sign, and mail a paper application to the NPI Enumerator address on the form.
For a copy of the application (Form CMS-10114, “NPI Application/Update Form”), refer to the https://www.cms.gov/Medicare/CMS-Forms/CMSForms/Downloads/CMS10114.pdf on the CMS website.
To request a hard copy application through the NPI Enumerator, call 1-800-465-3203 or TTY 1-800-692-2326 or email customerservice@npienumerator.com.
Option 3
Permit an Electronic File Interchange Organization (EFIO) to submit application data through bulk enumeration.
For more information on this option, see below or refer to https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/apply.html.
What Must Covered Organizations Do When Applying for an NPI?
An organization health care provider that is a HIPAA-covered health care
provider must:
- Obtain an NPI.
- Determine if it has subparts and if those subparts need to have their
own NPIs. - Ensure its subparts that need to have their NPIs do so by either
obtaining the NPIs for them or instructing the subparts to obtain
their NPIs themselves. - Ensure the subparts comply with the NPI Final Rule requirements
placed on HIPAA-covered healthcare providers.
Organizations Applying for NPIs on Behalf of Employed Providers
The steps below guide organization health care providers who wish to apply for NPIs or submit updates to the NPPES on behalf of their employed health care providers.
NOTE: The process described below is NOT the Electronic File Interchange (EFI) for bulk enumeration. Instead, an organization that is a health care provider should follow these steps when applying for an employee’s NPI on an individual record-by-record basis.
Step 1 – Confirm Employee’s Current NPI Status
Ensure the health care providers for whom the organization will apply do not already have NPIs.
Step 2 – Verify Agreement With Health Care Provider Employees
Determine if an agreement between the organization’s health care provider and its employees gives the organization the appropriate legal authority to act on behalf of those health care providers in actions such as completing NPI applications and updating transactions on their behalf.
You may need legal counsel to determine if an existing agreement covers these actions. If such an agreement exists, the organization may not need to take the actions described in items 3–5 below.
Step 3 – Notify Health Care Provider Employees of Collected Information
Ensure the health care providers know about the information collected on the NPI Application/Update Form (CMS-10114), which is available at http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10114.pdf on the CMS website.
Ensure they read the “Penalties for Falsifying Information on the National Provider Identifier (NPI) Application/Update Form,” “Certification Statement,” and “Privacy Act Statement” sections of that form and agree to all relevant requirements.
Step 4 – Validate NPI Application Data
Share the NPI application data with the healthcare providers represented in the application to ensure complete and correct data. The same applies to updating information.
Step 5 – Retain NPI Documents
Ask the healthcare providers to sign a document indicating that you took the above actions. Retain those documents as proof that they knew about the actions taken on their behalf.
Step 6 – Designate a Contact Person for NPI Confirmation
The NPPES emails the “Contact Person” entered on a healthcare provider’s NPI application.
This email informs the Contact Person of the enumerated healthcare provider’s NPI. It contains some identifying information about the provider (including the provider name, address, and Healthcare Provider Taxonomy Code and description).
If the organization submits an NPI application on behalf of a healthcare provider employee, the Contact Person designated by the organization receives the NPI notification email from the NPPES.
The Contact Person must forward that notification (or a copy) to the healthcare provider employee. This notification confirms that the NPPES assigned the healthcare provider employee an NPI and contains the NPI.
Organizational healthcare providers may feel it appropriate to have their legal counsel review this process.
Electronic File Interchange (EFI)
The EFI is an alternative process for healthcare providers applying for an NPI.
Each EFIO can submit NPI application information for hundreds or even thousands of healthcare providers simultaneously in a single or a series of electronic files.
EFI benefits both healthcare providers and CMS. By allowing an EFIO to apply on its behalf, a healthcare provider does not have to apply for an NPI, which saves the provider time and resources.
CMS benefits by saving the time and resources it would have expended if the NPI Enumerator (contractor that processes NPI applications) and the web-based system had to process NPI applications one at a time.
In addition to obtaining NPIs for healthcare providers, some EFIOs may also send changes or updates to the NPPES on behalf of enumerated healthcare providers to keep the providers’ NPPES records current.
The EFIO needs permission from the healthcare providers to send changes or updates. The decision to furnish changes or updates to a healthcare provider’s NPPES record is between an EFIO and its associated healthcare providers.
If the provider and EFIO agree on the EFIO to submit future changes on the provider’s behalf, it is still ultimately the provider’s responsibility to ensure that
any updated information is furnished to the NPI Enumerator.