Do Nurses Have NPI Numbers? With 12 Best Tips for You

Nurses that are currently working in health research via huge healthcare plans or healthcare systems will, in many cases, be required to have an NPI number.

Do nurses have NPI numbers?

The function of having an NPI number is to replace the need for having many types of identification numbers at once.

In addition, NPI numbers will be retained throughout your entire career regardless of the changes made to your current location and job.

What is an NPI number?

An NPI number is a ten-digit numeric identifier that doesn’t have any information about yourself, such as the state in which you operate, your specialization, or your provider type.

Your NPI number is going to be completely permanent, and it will not change regardless of any changes made to your address, name, and other personal information.

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Table of Contents

Do registered nurses have NPI numbers?

Every Advanced Practised Registered Nurse that bills health insurers directly for the nursing services via electronic billing are compulsory to apply, obtain and use NPI numbers.

Hence, registered nurses will most likely have an NPI number as they’re required by law to have one and use it.

In other words, registered nurses are required to have an NPI number and enroll with NPPES if they want to bill Medicare or Medicaid for services.

Therefore, they will need to obtain an NPI number right before making enrollment in the Centre for Medicare and Medicaid Service (CMS).

Examples of individuals that are eligible to apply, obtain and use NPI numbers are as follows:

All nurses
Physicians
Psychologist
Pharmacists
Chiropractors
Dentists
Physicians
Physical Therapists

Examples of organizations that are eligible to apply, obtain and use for NPI numbers are as follows:

Clinics
Ambulance Companies
HMOs (Health Maintenance Organizations)
Group Practices
Hospitals
HHAs (Home Health Agencies)
Laboratories
Pharmacies
Nursing Homes
DME Suppliers (Durable Medical Equipments)
Residential Treatment Centers

Do nurse practitioners have NPI numbers?

Nurse practitioners are not required to have an NPI number to be approved to be a nurse practitioner, specifically in North Carolina.

However, since all nurses fell under the HIPAA-covered entities, in most cases, nurse practitioners will most likely have NPI numbers.

As listed in the article previously, all of the individuals listed are considered to be HIPAA-covered entities.

Do nurses need NPI number?

Every healthcare providers and professionals categorized as HIPAA-covered entities need to have an NPI number to reap the benefits that come with having one.

Keep in mind here that many individuals and organizations that fall into this category are also eligible to apply for an NPI number.

HIPAA-covered entities are individuals or organizations that are categorized as healthcare providers that:

conduct transactions electronically
transmit health information electronically
involved in healthcare clearinghouse
involved in health plans (which includes Medicare and Medicaid)

Apart from that, you will also need an NPI number if you wish to submit an application for your enrollment in medicare.

This is because the NPI enumerator will automatically reject any submitted applications that don’t have NPI numbers included in them.

Which transactions are considered as HIPAA Standard Transactions?

HIPAA standard transactions are known as any exchanges that involve the transfer of data between two groups for a particular objective.

See also: Objective vs Subjective Data

HIPAA regulations have established the following transactions for EDI (Electronic Data Interchange) of data that involves healthcare:

Remittance advise and payments
Claims status
Claim and encounter info
Referrals and authorization
Coordination of benefits and premium payment
Eligibility, enrollment, and dis-enrollment

What are the benefits of having an NPI number?

One of the benefits of having an NPI number is that it provides instant and simple electronic connections of HIPAA standard transactions.

This will help increase the efficiency of medical organizations and help make the job of most medical providers a lot easier.

Besides that, the NPI number also helps to provide you with a universal health identifier that can be used by most health providers, employers, and healthcare plans.

Finally, NPI numbers also help to ensure efficient coordination of benefit transactions in the future.

Myths and misconceptions about NPI number

Please bear in mind that getting an NPI number will not:

Automatically make it compulsory for you to conduct any HIPAA transactions
Automatically grant you any type of license or credentials
Replace or change any type of certification process or your current Medicare enrollment
Guarantee you to get any health payment plan
Automatically enroll you in any health plan

How to search for an NPI number?

Suppose you need to search for more information regarding the healthcare provider.

In that case, you should head to the NPI Registry, an online query system that enables you to find all of the information you need regarding a certain healthcare provider.

NPI numbers and information linked to health care providers are assigned, updated, and maintained by the National Plan and Provider Enumeration System (NPPES).

Apart from that, NPPES is also responsible for disseminating the NPPES Downloadable Files and NPI registry.

Lastly, you should also try to check out the NPPES Downloadable File, which contains helpful information about every healthcare provider together with their respective NPI numbers.

Who are compulsory to get an NPI number?

Every healthcare provider categorized as a HIPAA-covered entity, regardless of whether they are individuals or organizations, is compulsory to get an NPI number.

Who are not eligible to apply for an NPI number?

Any entity that does not meet the written definition of a health care provider like how it has been stated in the 45 CFR 160.

103 will be prevented from applying for an NPI number.

Examples of these entities would be value-added networks, billing services, health plans, healthcare clearinghouse, transportation services (non-emergency), and others.

How to apply for an NPI number?

Currently, healthcare providers have three options to apply for an NPI number, and they may choose the one that they prefer the most.

Solution 1: Utilizing NPPES

The first solution is to make an NPI application via NPPES via a web application.

Individual healthcare providers will need to create a username and password via the Identity and Access management system.

They may then be able to log in to NPPES by using the username and password that has been newly created.

Solution 2: Offline form

The second solution is by filling out the offline application form, get it signed by you, and mail the form CMS-10114, NPI Application/Update Form, to the address of the NPI Enumerator stated in the application form.

If you would like to request the hard copy application via the NPI Enumerator, then you may get in touch with them at 800-465-3203.

You may also send an email to their customer service at [email protected]

Solution 3: Granting permission to EFIO

The third solution is by allowing Electronic File Interchange (EFI) to send your application’s data via a bulk enumeration process.

The only thing that you need to do is to permit them to do so.

This is by far the simplest and fastest way to apply for an NPI number.

Can nurses practice without an NPI number?

The answer is a simple no.

It’s highly recommended for every nurse to get their own NPI numbers.

There are some specific situations in which NPI numbers are required by certain health plans to proceed with the claims processing process.

What is the main function of an NPI number?

Before the invention of the NPI number, there was no standard way to identify every healthcare provider in the country.

The lack of coordination causes inefficiency and confusion to be widespread in the system.

Hence, the NPI system was introduced to improve the efficiency and coordination of the system.

All healthcare providers use this number to identify one another in any healthcare correspondence and transactions.

For example, it can be used by pharmacies all around the country to identify which healthcare providers are on prescriptions.

Lastly, NPI numbers can also be used by the electronic medical record system to identify healthcare providers that are in the patient records.

Are NPI and DEA numbers the same thing?

No, they’re not.

Don’t get confused between NPI and DEA numbers.

NPI numbers are not a substitution or replacement for DEA numbers.

Not every healthcare provider with an NPI number will be qualified to get a DEA number.

At the same time, you can expect to see that all providers with a DEA number will have an NPI number.

DEA numbers are obtained from the Drugs Enforcement Administration to multiple providers, including physicians, dentists, optometrists, physician assistants, and veterinarians.

DEA numbers enable healthcare providers to write the correct prescriptions for all of the controlled substances.

It’s also being used by the DEA to monitor the prescriptions of the provider and detect any forms of abuse or fraud.

Conclusion: Do nurses have NPI numbers?

In a nutshell, regardless of whether you’re a registered nurse or nurse practitioner, for as long as you fell under the HIPAA-covered entities, you will most likely need to have and use an NPI number.

It’s safe to say that the majority of the healthcare providers, such as nurses, do have NPI numbers because they want to get the benefits of having an NPI number.

At this point, you should have a clear understanding of whether do nurses have NPI numbers or not.

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Do Nurses Have NPI Numbers or Not?