Q:

What kind of information does an NPI look up provide?

A:

Quick Answer

A national provider information, NPI, search provides access to the national plan and provider enumeration system, NPPES, of health care provider information and the unique identifier assigned by it. The search also returns the provider's general information, practice mailing and physical address, provider taxonomy and other information.

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Full Answer

NPPES was developed by the Centers for Medicare and Medicaid Services, CMS, to issue NPI identifiers in compliance with the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996, HIPAA. HIPAA mandates the assignment of standard unique identifiers for health care providers and plans to improve the efficacy and efficiency of electronic health record-keeping.

An issued NPI is a 10-digit number that carries no identifying information about the provider or plan. The NPI replaces any legacy provider identifier in standard transactions as required by HIPAA since May 23, 2008. Federal regulations require that physicians and other health care providers share their NPI with health plans, clearinghouses and other entities that require it for billing purposes.

NPI data is subject to Freedom of Information Act, FOIA, requests. CMS disseminates NPI data via the Internet by providing the NPI search tool in downloadable format as monthly complete-update files and weekly incremental files. There is no charge associated with the access of NPI data either through the search tool or by the downloading of files.

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