NPI and NPPES
CMS directs providers and suppliers to obtain an NPI through the National Plan and Provider Enumeration System (NPPES) as an early step in Medicare enrollment. An NPI identifies a health care provider in standard electronic transactions but does not, by itself, establish payer participation or payment eligibility.
Type 1 and Type 2
Type 1
An individual health care provider, such as a physician or other eligible practitioner.
Type 2
An organization health care provider, such as an entity, group or facility that qualifies for an organizational NPI.
Claims relationship
Professional claims may include billing, rendering, referring or ordering provider information depending on the service and payer requirements.
Taxonomy codes
Taxonomy codes classify provider type, classification and specialization. Enrollment teams should use the provider's accurate, current taxonomy information and follow the specific payer's rules for primary or additional taxonomy reporting.
Keep source data current
- Review NPPES information when provider demographics or practice details change.
- Confirm the correct individual and organization relationships.
- Avoid assuming that an NPI update automatically changes every payer enrollment record.
Quick knowledge check
Which system issues NPIs?
NPPES.
Does having an NPI mean the provider is enrolled with every payer?
No.
What do taxonomy codes communicate?
The provider's type, classification and specialization.
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