National Provider Identifier
On May 1, 2006, the Centers for
Medicare & Medicaid Services (CMS) introduced
the revised CMS 855 Medicare provider enrollment applications.
As part of the revised enrollment process, initial
enrollees and existing enrollees making changes to
their enrollment information must include their National
Provider Identifier (NPI) number and a copy of the
National Plan and Provider Enumeration System (NPPES)
NPI notification with the enrollment application.
No initial application can be approved and no updates
to existing enrollment information can be made without
this NPI information. All health care providers and
suppliers who bill Medicare are required to obtain
their NPI in advance of enrolling in or changing their
Medicare enrollment data.
If you are an individual or sole proprietor,
who furnishes health care, you are eligible for one
and only one NPI. If you are an individual who is
a health care provider and who is incorporated, you
may need to obtain an NPI for yourself and an NPI
for your corporation or LLC. If you are an organization
that furnishes health care, you may determine that
you have components, called “subparts,”
that need their own NPI. For additional information
about the NPI, please go to http://www.cms.hhs.gov/NationalProvIdentStand/.
If you have not yet obtained your NPI
number, CMS encourages you to do so soon even if you
are not enrolling or making a change to your Medicare
enrollment information. Attached is an information
sheet designed to provide basic information about
the NPI, including the three different ways to apply
for your NPI. Whatever method you use to obtain your
NPI, be sure to keep this information, share it with
your health care partners, and update your information
with NPPES whenever any of the information used to
get your NPI changes.
Starting May 23, 2007, the NPI will
replace all of your existing provider numbers that
you use to bill Medicare, Medicaid, and other health
care payers. Although this date is still a year away,
you should begin sharing this information with Medicare,
other payers, and your other health care partners
in order to make the transition to NPI as smooth as
For more information about the
revised provider enrollment process, please contact
your Medicare contractor or go to http://www.cms.hhs.gov/MedicareProviderSupEnroll.
The Centers for Medicare &
Medicaid Services announces the following plans for
transitioning to the National Provider Identifier
(NPI) in the Fee-for Service Medicare Program:
Between May 23, 2005 and January 2,
2006, CMS claims processing systems will accept an
existing legacy Medicare number and reject, as unprocessable,
any claim that includes only an NPI.
Beginning January 3, 2006, and
through October 1, 2006, CMS systems will accept an
existing legacy Medicare number or an NPI as
long as it is accompanied by an existing legacy Medicare
Beginning October 2, 2006, and
through May 22, 2007, CMS systems will accept an existing
legacy Medicare number and/or an NPI. This
will allow for 6-7 months of provider testing before
only an NPI will be accepted by the Medicare Program
on May 23, 2007.
Beginning May 23, 2007, systems
will only accept an NPI .
For additional information,
to complete an NPI application online,
and to access educational tools, visit https://nppes.cms.hhs.gov
on the web.