GlossaryGuide

Who May Obtain an NPI?

All health care providers (that is, physicians, suppliers, hospitals, and others) may obtain an NPI. Health care providers are individuals or organizations that render health care as defined in 45 Code of Federal Regulations (CFR) 160.103. For more information, refer to 45 CFR 160.103 on the Government Printing Office (GPO) website.

Who Must Obtain an NPI?

All health care providers who are HIPAA-covered entities, whether individuals or organizations, must obtain an NPI.
A HIPAA-covered entity is a:

• Health care provider that conducts certain transactions in electronic form
• A Health care clearinghouse
• A Health plan (including commercial plans, Medicare, and Medicaid)

Under HIPAA, you are a covered health care provider if you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so. For more information and to access a tool to help you determine whether you are a covered entity,

Table 1 provides examples of common health care providers who are HIPAA-covered entities.

Who May Not Obtain an NPI?

Any entity that does not meet the definition of a health care provider as defined in 45 CFR 160.103 may not apply for an NPI. Such entities include billing services, value-added networks, repricers, health plans, health care clearinghouses, non emergency transportation services, and others.