Can you look up NPI numbers?

The NPI Number is the only healthcare provider identifier that can be used in regular transactions by covered organizations for identification purposes. HIPAA mandates the use of NPI numbers in regular transactions by covered organizations. To process all medical claims, the NPI number must be used instead of legacy provider identifiers like the UPIN in HIPAA standards transactions. Find your NPI number using best NPI lookup tool.

HIPAA has required healthcare providers to use a common unique number since 1996. The NPI number was adopted as the standard for healthcare provider recognition by the NPI Final Rule, which was published in January 2004. The NPI has taken over as the mandatory identifier for all Medicare programs, including health insurance claims, replacing the UPIN (Unique Provider Identification Number).

The value is hidden within NPI data

General identifiers, contact information, and taxonomy are all included in publicly accessible NPI data. The aggregation of public records, on the other hand, will reveal more meaningful details, such as ongoing monitoring history, mutual relationships with doctors and other healthcare providers, and referral analysis – all of which can affect your bottom line.

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How to Conduct NPI Lookups

The National Provider Identifier (NPI) Registry Public Search is a free archive of all active NPI information. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry.

The CMS National Plan and Provider Enumeration System are where individuals and organizations apply for NPIs (NPPES). They publish the sections of the NPI record that are relevant to the public, such as the provider’s name, specialty (taxonomy), and practice address after we have received an NPI. This service is provided by CMS as per federal law (45 CFR Part 162). They also supply this directory in a full download file, or through an Application Programming Interface (API).

You can search the details by following data:-

  • NPI Number (To find providers by NPI number, use a reverse NPI lookup.)
  • First & Last Name (Individual providers can be found using their first and/or last names.)
  • Group Name (Organizations and medical associations can be found by name.)