How to Apply for your National Provider Identifier Number (NPI)
New Webinar about National Provider Identifier (NPI)
NPI Enumeration for Dentists and Dental Practices
November 22, 2019
2 - 3 PM CT
What is NPI?
The National Provider Identifier (NPI) is a unique, government-issued, standard identification number for individual health care providers and provider organizations such as clinics, hospitals, schools and group practices. NPIs that specify an individual, such as a solo practice dentist, are classified as Entity Type 1 (Individual) NPIs. NPIs that specify organizations, such as hospitals, group practices, and professional corporations, are classified as Entity Type 2 (Organization) NPIs.
How to Apply for NPI
Applying for a NPI is free of cost and relatively easy. To apply, visit the National Plan and Provider Enumeration System website. Those with valid applications should receive their NPI via email within one to five business days. The emails may end up in a spam folder, so it’s important to check regularly (including your spam folder) to ensure you receive the message.
Dentists who prefer to submit paper applications should contact the NPPES customer service hotline at 800.465.3203. The paper application process should take between four and six weeks. Questions about the status of an NPI application can be emailed to customerservice@NPIEnumerator.com.
During the application, you will be asked for your "Provider Taxonomy Code." This is an alphanumeric code that designates a health care provider's area of specialization. See the list of Provider Taxonomy Codes (PDF)
For more information about NPIs in general, please visit Center for Medicare and Medicaid Services website.
Any health care provider that uses electronic transactions—like claims or eligibility verifications—is considered a “covered health care provider” under the Health Insurance Portability and Accountability Act (“HIPAA”) and is required include an NPI on electronic transactions wherever one is needed to identify a provider individual or provider organization. This definition applies regardless of whether the provider submits electronic transactions directly or via a third party, like a vendor or a clearinghouse.
Medicare Part D Changes Affecting NPI Use
Since Jan. 1, 2013, all Medicare Part D prescription claims must contain the prescriber’s Type 1 individual NPI. Even a dentist who does not normally need a Type 1 individual NPI to bill for his or her services still needs this identifier to prescribe drugs for patients who have Medicare Part D prescription drug benefits.
As of May 6, 2013, a Type 2 Organizational NPI that identifies a dental practice organization is no longer sufficient to allow patient prescriptions to be billed to third-party insurance carriers. Only the Type 1 individual NPI is now valid for specifying the prescribing doctor on an pharmacy claim.
Other NPI Users
Even dentists who are not HIPAA covered entities may be required to use NPIs. For example, most dental plans require dentists to include NPIs on paper claim submissions (since 2006, all versions of the ADA claim form support the use of NPIs). Non-covered dentists are now also required to use a Type 1 NPI on prescriptions for Medicare Part D beneficiaries.
In addition, a specialist may request a referring doctor’s Type 1 individual NPI to complete a claim, regardless of how the claim is transmitted to the plan. A pharmacy benefits plan may require pharmacists to include prescribing doctors’ Type 1 NPIs on prescription claims for certain drugs.
American Dental Association
Department of Dental Informatics
ADA business hours are 8 a.m. to 5 p.m. U.S. Central Time