National Provider Identifier (NPI)

Overview

The National Provider Identifier (NPI) is a 10-digit identification number used to uniquely identify a physician, a health care professional or an institution within specified electronic transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The NPI will replace legacy identifiers that are in use today, and will eliminate the need for different identification numbers for standard transactions with multiple health plans and programs. These standard transactions include claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advices.

NEMS MSO Compliance with NPI Requirements

North East Medical Services (NEMS) has reviewed the requirements of the NPI and is in the process of integrating NPIs into our information systems. We expect to achieve compliance with NPI requirements on or before the May 23, 2007 compliance date. After the compliance date, health care providers must only use their NPIs to identify themselves in standard transactions. For paper-based claims transactions, we strongly encourage the use of the NPI on the CMS 1500 (version 08/05) and UB-04 claim forms to minimize any disruption to claims payments.

How to Get an NPI Number

If you have not already done so, please apply for a NPI number through CMS' National Plan and Provider Emumeratory System (NPPES).

For more information on the NPI standard, please visit the CMS website at http://cms.hhs.gov/NationalProvIdentStand/. You can also call NPPES at 1-800-465-3203 or TTY 1-800-692-2326.

Registering Your NPI Number with NEMS MSO

Once you receive your new NPI, please register the number with NEMS by Tuesday, May 15, 2007. Registration of your NPI with NEMS will ensure a seamless conversion in our internal systems and minimize the potential for payment disruptions.

Register with a form: You may register your NPI by downloading a NEMS NPI Registration Form ( Word | PDF ). Please be sure to attach a copy of your NPI enrollment confirmation from NPPES. You may mail or fax completed forms and documents to:

NEM MSO Department
1520 Stockton Street
San Francisco, CA 94133
Fax: (415) 433-4726

Register via email: You may also register your NPI numbers with us by emailing NEMS MSO the following information PLUS a copy of your NPI enrollment confirmation from NPPES:

• Full Provider Name and Title:
• Provider NPI Number:
• Provider Specialty:
• Federal Tax ID Number:
• Legal Business Name:
• Business Address:
• Office Phone Number:
• Office Fax Number:
• Provider CA License Number and Expiration:

Please click here to generate an email form for submission.
(Only available for Microsoft Outlook users.)

NEMS will continue to relay information from CMS regarding NPI and NPPES. You can obtain information about the NPI or any breaking news by visiting the CMS website at http://cms.hhs.gov/NationalProvIdentStand/. You can also call NPPES at 1-800-465-3203 or TTY 1-800-692-2326.