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APPLYING FOR NPI (WITH NPPES)

The following provides information on how to obtain an NPI from the National Plan and Provider Enumeration System (NPPES).

The NPI Final rule designates two categories of health care providers for the enumerating process:

  • Entity Type Code 1 – Health Care providers who are individual human beings, including dentists and hygienists, and sole proprietorships-regardless of multiple service office locations.
  • Entity Type Code 2 – Health Care Providers who are organizations, including dental practices, and/or individual dental practices who are incorporated. Please remember that many providers will need to get 2 NPIs. Both an Entity Type Code 1 and Entity Type Code 2.

The key application data elements are as follows:

  • Entity Type
  • Provider name
  • Other name used (if applicable)
  • Practice location, address, and phone number
  • Mailing address and phone number
  • Social Security Number (or alternative proof of identity for individuals)
  • IRS TIN (for individuals)
  • Employer Identification Number (for organizations)
  • Date, state, country of birth and gender (for individuals)
  • Taxonomy
  • License number and state
  • Other provider identifiers used
  • Authorized official (for organizations)
  • Contact information

How Does a Provider Get an NPI from NPPES?
Providers can obtain an NPI through one of three following application options: 1) Paper Application, 2) Web Application and 3) Electronic File Interchange (EFI).

1. PAPER APPLICATION – The National Provider Identifier (NPI) Application/Update Form (CMS-10114) can be obtained by contacting the NPI Enumerator through the following options:

Telephone: 800-465-3203 or TTY/TTD 800-692-2326

E-mail:  customerservice@npienumerator.com

Mail:      NPI Enumerator
             P.O. Box 6059
             Fargo, ND 58108-6059


The paper application should be completed, signed and mailed back to the Enumerator (retain a copy for your records). Upon completion of the application process, a confirmation document from NPPES will be mailed to the designated contact person in approximately 20 calendar days. Keep this confirmation document for your records.

2. WEB APPLICATION

Providers can apply for an NPI through direct data entry into the National Plan and Provider Enumeration System (NPPES) NPPES Web site. To enter data, the provider must create a user ID and password on the NPPES Web site. Upon completion of the application process, a confirmation document from NPPES will be e-mailed to the designated contact person within five calendar days. Keep this confirmation document for your records.

3. ELECTRONIC FILE INTERCHANGE (EFI)

The NPPES allows approved EFI filing organizations to submit multiple applications in one batch file instead of single paper or Web applications. The EFI filing organization must obtain authorization from each provider and must certify the accuracy of the data. After the NPIs are issued, the EFI filing organization will be responsible for distributing the NPIs to providers. Information on EFI bulk enumeration is available at https://nppes.cms.hhs.gov/NPPES/EFIHome.do.

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