We're here to help you understand the National Provider Identifier (NPI) process. Here are some guidelines and information about the regulation and its requirements.
Every health care provider transmitting health information in connection with a standard transaction in electronic form must obtain an NPI. An NPI is required by HIPAA for electronic transactions.
All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI.
If you answer "yes" to any one of the following questions, you are considered a "covered entity" under the NPI standard and are required by federal law to obtain an NPI.
If any data related to your NPI changes (name, address, etc.), you are responsible for submitting an update to the NPPES within 30 days of the change.
There are two types of NPIs: Type 1, for individual health care providers, such as dentists and hygienists, and Type 2 for incorporated businesses, such as group practices and clinics.
On claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form (#J400), the treating dentist's NPI is entered in field 54 and the billing entity's NPI is entered in field 49.
|Practice Type||NPI Type|
|Solo practitioner||Type 1 only, if claims are transmitted in the dentist's name and social security number.|
|Individual dentist at one practice location||Type 1 for the dentist and Type 2 for the practice, if claims are transmitted in the practice's name and Tax Identification Number (TIN)|
|Multiple dentists, one practice location||Type 1 for each dentist and Type 2 for the practice, if claims are transmitted in the practice's name and TIN|
|Multiple dentists, multiple practices||Type 1 for each dentist and Type 2 for each practice with a separate TIN
I submit paper claims and don't use the Internet to check patient eligibility and benefits. Do I still need an NPI?
If you don't conduct any electronic transactions governed by HIPAA, you aren't required to obtain an NPI. However, we strongly encourage you to get one, because you can use it as a single unique identifier with all payers.
How is the NPI determined?
NPIs are issued by the National Plan & Provider Enumeration System (NPPES). The NPI contains no embedded intelligence — no coding that would identify the dentist's state or license number, for example. It is simply a random number that does not expire.
How will the NPI affect other numbers I've used in the past?
The NPI replaces other identifying numbers used in electronic transactions, such as:
The NPI will not replace these numbers, which are used for purposes other than general identification:
Where can I get help with the NPI application?
The NPI Enumerator will help you with your NPI application and to update your information in the NPPES.
NPI TTY: 800-692-2326
Mail: NPI Enumerator
P.O. Box 6059
Fargo, ND 958108-6059
For questions about these notices, please call us at 866-530-9675.
You may also write to us at
Delta Dental of California
P.O. Box 997330
Sacramento, CA 95899-7330