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National Provider Identifier / NPI

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Please note: The ADA does not provide specific answers to individual questions about fees, dental problems, conditions, diagnoses, treatments or proposed treatments, or requests for research. Information about dental referrals, complaints and a variety of dental procedures may be found on ADA.org.

Overview

 

The National Provider Identifier (NPI) is a unique, government-issued, standard identification number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices. The government has contracted with an external company to run the National Plan and Provider Enumeration System (NPPES) for processing applications and managing NPI associated data. Applications to obtain NPIs from the NPPES began on May 23, 2005.

Any health care provider who uses standard electronic transactions, like electronic claims or eligibility verifications, has been required by federal law to include an NPI or NPIs on electronic transactions since May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may be required to use NPIs.  For example, most dental plans require dentists to include NPIs on paper claim submissions.  In addition, a specialist may require a referring doctor's Type 1 individual NPI to submit a claim regardless of how it is transmitted to the plan.   

Effective January 1, 2013, all Medicare Part D prescription claims submitted to CMS must contain the prescriber's Type 1 Individual NPI.  Although a dentist may not need a Type 1 Individual NPI to bill for his or her services, this identifier is needed for their patients who have Medicare Part D prescription benefits.  As of May 6, 2013, a Type 2 Organizational NPI that may belong to the dental practice is no longer sufficient to allow prescriptions for their patients to be billed to third party insurance carriers. 

For the above reasons, the ADA strongly encourages dentists who do not have Type 1 Individual NPI to obtain Type 1 individual NPIs immediately.

Applying for an NPI is free and relatively easy: To apply via a secure web-based process, visit the National Plan and Provider Enumeration System (NPPES) website, read the instructions carefully, complete the questionnaire, and submit your application. This takes about 20–30 minutes. You must supply a valid email address to complete your application; a confirmation that your application was accepted will be sent to that email address. After confirmation of your data’s receipt, you should receive your NPI via that same e-mail in one to five business days. Please note that if you have spam filtering on your email interface, replies from the NPPES, including the one with your NPI and confirmation message, may be intercepted and diverted to a spam folder. If your email service supports such a feature, please be sure to check this folder regularly after submitting your data. The message will come from Customerservice@NPIEnumerator.com. If you prefer to submit a paper application, contact the NPPES customer service hotline at 800-465-3203 to request a paper application form. The paper application process takes approximately 20 business days.

Questions about the status of an NPI application may be e-mailed to Customerservice@NPIEnumerator.com.

Please direct all other questions, comments, or concerns to NPI@ada.org.

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