There is no shortage of paperwork for residents, with different bureaucratic tasks popping up at various times before, during and soon after training. One of those tasks is obtaining a National Provider Identifier (NPI), a 10-digit identifying number that typically travels with a physician throughout their career in medicine.
With that in mind, physicians entering residency training or in their internship year may ask themselves: When is the right time to get an NPI number, and what is the best way to go about doing so?
NPI numbers are an essential part of billing under virtually every kind of insurance plan, including Medicaid, Medicare and the vast majority of private plans. Anyone providing patients with health care—including physicians, nurses, dentists, physical therapists and pharmacists—as well as organizations that offer health care or health care supplies, may be required to get an NPI number.
Read on for more information about the process of applying for an NPI number, and to learn more about when most physicians will get one.
NPI number may not be required in residency
Starting in 1996 with the adoption of the Health Insurance Portability and Accountability Act (HIPAA), physicians, other health care professionals and health care plans were required to use unique, standardized identifiers managed by the Centers for Medicare & Medicaid Services. Compliance was required as of 2007. Physicians prescribing medication and referring patients must have an NPI number, though the identifiers are not a reflection of a physician’s licensing or credentialing status.
Though there’s no doubt that all physicians will eventually get their own NPI number, the best time in residency to apply for one will vary. Some training programs require that residents come in with an NPI number. Others will ask residents to obtain an NPI number at some point in their training. Residents and interns who will not be prescribing medication or referring patients may not need an NPI number, but those who are moonlighting at another facility will almost certainly need one.
“There are some reasons that health systems may wish for their trainees to have NPI numbers for billing purposes, but it’s not universal,” said John Andrews, MD, the AMA’s vice president for medical education and professional development. “There are reasons that you may need one that would either be dictated by the health system in which you’re working or perhaps by your own priorities, but it’s going to vary by individual.”
Dr. Andrews recommended that residents who aren’t told to obtain an NPI number before or in their internship year take guidance from the graduate medical education officer at their training program about when might be a good time to get one.
For residents looking to learn more about the process of transitioning to practice, a video called "Physician Credentialing Demystified”—produced by FREIDA™, the AMA Residency & Fellowship Database®—offers insight on the process.
Online process recommended for applications
Residents can apply for an NPI number for free at the National Plan and Provider Enumeration System (NPPES) website. First, you must create an account. Then, an application can be filled out online—which is the preferred form—or printed out and mailed in.
Physicians will need to select whether they are applying on their own behalf or for a health care organization. Physicians applying for themselves do so as individuals. Those unsure of which status they should apply under—for example, those in solo practice—should consult their professional society, health plan or a lawyer experienced in health care regulations.
A physician, as an individual, should only have one NPI number, even if they work in different capacities, licenses or practice locations.
To get an NPI number, physicians will need to enter a 10-digit taxonomy code that indicates their specialty and the kind of health care they provide. The taxonomy for residents who are not yet licensed is “Student Health Care” (390200000X).
Once a physician obtains their license, they should update their NPI data on the NPPES website to reflect the new taxonomy that corresponds with the specialty in which they are licensed. To do that, log in and select the “manage applications” tab. There are some changes, however, that can only be made in print: changes to dates of birth, Social Security numbers and reactivations of deactivated NPI numbers.
NPI numbers can be deactivated for a number of reasons, including retirement or death. A physician may also choose to deactivate an NPI number if it was created with incorrect data, was compromised in identity theft or was misused by another party. If a number is permanently deactivated, it is taken out of use and will not be reassigned to any other health care individual or organization.
For residents preparing to enter the job market, the AMA provides many resources to help physicians understand employment contracts, such as the Annotated Model Physician-Group Practice Employment Agreement (PDF) and the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), both free to AMA members.
Also, take time to learn about the “AMA Principles for Physician Employment” adopted by the AMA House of Delegates, which are designed to help physicians and employers address challenges such as contracting, conflicts of interest, payment agreements, and advocacy for patients and the profession.
