Every dental practice needs a National Provider Identifier, or NPI, to transmit any health information electronically. These HIPAA-mandated numbers require an application process but offer convenience to your practice once they are set up.

NPI 101

Every healthcare provider that transmits health information in an electronic form is required to have an NPI. A National Provider Identifier is a 10-digit, completely randomized number unique to each practice. These numbers are permanent and do not change or expire. NPIs replace other identification numbers used in electronic transactions like UPIN, but do not replace DEA numbers, taxpayer ID numbers (TINs) or social security numbers. NPIs are issued by the federal government through the National Plan & Provider Enumeration System (NPPES).

Do You Need a National Provider Identifier?

You need an NPI if:

  • You use a clearinghouse
  • You submit claims electronically
  • You submit attachments to claims electronically
  • You use the Internet to verify insurance eligibility or check claim status

How Can You Apply?

The application process is relatively simple. Click here to submit your application online or receive a paper application you can mail in. Once the NPPES receives your application, your dental practice should receive your NPI via email within five business days if you submitted online.

Which Type of NPI Should You Apply For?

Much of the confusion around NPIs comes from the existence of two types. Type 1 NPIs should be used by a healthcare provider. If you receive payments under your social security number or in your name, Type 1 should be what you apply for. Practices with multiple dentists should have a Type 1 NPI for every dentist in the office. Type 2 NPIs are for group practices, like incorporated dental practices. If you receive payments under a corporate name or business name, or under an EIN, you should have a single Type 2 NPI. When you submit claims, you should use a Type 2 NPI to identify the payee and, if appropriate, include the Type 1 NPI for the dentist that provided the treatment.

Streamline Your Dental Practice with APEX Reimbursement Specialists

The experts at APEX Reimbursement Specialists can help you organize your dental practice for continued growth and sustained success. We can work with you to demystify the credentialing and NPI processes. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.