National Provider Identifier

  1. Do I need to submit supporting documents to verify the National Provider Identifier (NPI) entered on the 855A form?
  2. How many National Provider Identifier (NPI) numbers do I need?
  3. How do I correct the National Provider Identifier Notification information if it is not correct?
  4. According to the National Plan and Provider Enumeration System (NPPES), Other Identification numbers are not required (optional). Is this true for Medicare part A?

Q1 - Do I need to submit supporting documents to verify the National Provider Identifier (NPI) entered on the 855A form?

A1 - Yes. Anytime an 855A application is completed and submitted, the application must include a copy of the NPI notification (letter or e-mail) received from the National Plan and Provider Enumeration System (NPPES). The NPI notification must include the following information:

  1. Legal Name (as reported with the Internal Revenue Service (IRS))
  2. Tax Identification Number or EIN
  3. Primary Practice Location Address with the 9-digit zip code
  4. Other ID - Medicare Part A number(s) (OSCAR number)

Taxonomy codes identifying the provider type.

Q2 - How many National Provider Identifier (NPI) numbers do I need?

A2 - It is entirely up to the organizational structure of your company to determine how many NPI numbers will be necessary. Medicare strongly encourages a provider obtain a One Medicare Provider Number to One National Provider Identifier ratio.

If a provider chooses to select 1 NPI to multiple Medicare Provider Numbers, please ensure the NPI notification identifies all Medicare Provider Numbers (OSCAR) and all taxonomy codes (provider types) are listed. This will help ensure proper payment after May 23, 2007

If a provider chooses to select multiple NPI numbers to 1 Medicare Provider Number (OSCAR), please include all NPI notifications with the 855A application. If an NPI identifies each additional practice location that operates with the same Medicare provider number, please complete section 4 of the 855A for each practice location and identify which NPI is assigned to what practice location. The primary practice location should always be the first section 4 listed on the 855A application.

Q3 - How do I correct the National Provider Identifier Notification information if it is not correct?

A3 - Once you obtain your User ID and your NPI status is Active, you may view and modify your NPI data. To obtain a revised NPI notification, please contact NPPES and ask for a revised NPI notification with the corrected data on the notification.

Important Info: User IDs cannot be changed. Once you have successfully chosen a User ID and submitted the record, this User ID will remain tied to your record and will not be changed.

If your NPI Status is Active, you can View/Modify your NPI data or change your password. Please contact the NPI Enumerator at 1-800-465-3203 if you have any questions or wish to deactivate your NPI.

If your NPI Status is Pending, you are only permitted to perform the Change Password function. After your application is processed and your NPI is assigned, you will be able to View/Modify your NPI Data. If the contact person has not received the provider's NPI via e-mail within 15 working days of submitting the application, please contact the NPI Enumerator at 1-800-465-3203.

If your NPI Status is Deactivated, you are only permitted to perform the Change Password function. You may not update NPI data for a deactivated NPI. Please contact the NPI Enumerator at 1-800-465-3203 if you wish to reactivate your NPI.

Q4 - According to the National Plan and Provider Enumeration System (NPPES), Other Identification numbers are not required (optional). Is this true for Medicare part A?

A4 - Although an identification number for other payers may not be required, it is required for a provider to submit their Medicare part A Identification number (OSCAR) to NPPES. If the Medicare number is not included or is not correct with NPPES, this will cause a provider's claim submission to reject after May 23, 2008.

Page Last Updated: Thursday, 15-Dec-2011 14:17:19 CST