Subpart D—Standard Unique Health Identifier for Health Care Providers

Under such system, the Secretary may impose appropriate fees on such physicians to cover the costs of investigation and recertification activities with respect to the issuance of the identifiers.

(b) Unique Health Identifiers.-- ``(1) In general.--The Secretary shall adopt standards providing for a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the health care system. In carrying out the preceding sentence for each health plan and health care provider, the Secretary shall take into account multiple uses for identifiers and multiple locations and specialty classifications for health care providers. ``(2) Use of identifiers.--The standards adopted under paragraph (1) shall specify the purposes for which a unique health identifier may be used.

It is the purpose of this subtitle to improve the Medicare program under title XVIII of the Social Security Act, the medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system, by encouraging the development of a health information system through the establishment of standards and requirements for the electronic transmission of certain health information.

NPPES health care provider data that are required to be disclosed under the FOIA will be available as a downloadable file on a Web site.

In accordance with the requirements of the Privacy Act of 1974, CMS is proposing to modify or alter existing system of records titled “National Provider System,” System No. 09-70-0008.

To an individual or organization fora research, demonstration, evaluation,or epidemiological project related to theprevention of disease or disability, therestoration or maintenance of health, orfor the purposes of determining,evaluating and/or assessing cost,effectiveness, and/or the quality ofhealth care services provided.

National Provider Identifier Standard (NPI)

NPS DATA ELEMENTS

We agree with commentersthat it would be costly to collect,validate, and maintain certification andschool information.

The NPI may also be used for anyother lawful purpose requiring theunique identification of a health careprovider.

HHS will exercise overallresponsibility for oversight andmanagement of the NPS.

The NPS will be designed to be easyto use. The design will employ the latesttechnological advances whereverfeasible for capturing health careprovider data and making informationavailable to users.

Communicate to the NPS anychanges to its required data elements inthe NPS within 30 days of the change.

A strong majority ofcommenters supported our proposalthat the NPI be intelligence-free.

We find the statedadvantages of a 10-position numericidentifier convincing. We have revisedproposed § 142.402 (now § 162.406(a))to provide that the NPI will be a 10position numeric identifier, with the10th position being an ISO standardcheck digit.

A health care provider’s NPI willnot be deactivated if that health careprovider is sanctioned or barred fromone or more health plans.

We do not consider individuals whoare health care providers (that is, theymeet our definition of ‘‘health careprovider’’ at § 160.103) and who aremembers or employees of anorganization health care provider to be‘‘subparts’’ of those organization healthcare providers, as described earlier inthis section.

We define two categories of healthcare providers for enumerationpurposes. A data element, the ‘‘Entitytype code,’’ in the NPS record for eachhealth care provider will indicate theappropriate category.• NPIs with an ‘‘Entity type code’’ of1 will be issued to health care providerswho are individual human beings.Examples of health care providers withan ‘‘Entity type code’’ of 1 arephysicians, dentists, nurses,chiropractors, pharmacists, and physicaltherapists.• NPIs with an ‘‘Entity type code’’ of2 will be issued to health care providersother than individual human beings,that is, organizations. Examples ofhealth care provider organizations withan ‘‘Entity type code’’ of 2 are: hospitals;home health agencies; clinics; nursinghomes; residential treatment centers;laboratories; ambulance companies;group practices; health maintenanceorganizations; suppliers of durablemedical equipment, supplies related tohealth care, prosthetics, and orthotics;and pharmacies

We decided not toestablish sub-IDs because our decisionsregarding which entities would beeligible to receive NPIs (includingseparate physical locations and subpartsof certain kinds of organization healthcare providers) obviate the need forthem. Sub-IDs may be useful as a laterimplementation feature that wouldsupport EDI routing or other purposes.We will consider an expansion at a latertime to include them, if we determinethat they would be beneficial.

For purposes of this rule, weconsider group health care providers tobe organization health care providers.

that the organization healthcare provider is a legal entity and is thecovered entity under HIPAA if it (or asubpart or component) transmits healthinformation in electronic form

We accommodate this language byrequiring covered health care providersto obtain NPIs for subparts of theirorganizations that would otherwisemeet the tests for being a covered healthcare provider themselves if they wereseparate legal entities, and permittinghealth care providers to obtain NPIs forsubparts that do not meet these tests butotherwise qualify for assignment of anNPI.

Therefore, because these kinds ofentities are not health care providers,they will not be eligible for NPIs.

Only those entitiesthat (1) meet the definition of healthcare provider at § 160.103, and (2)transmit health information inelectronic form on their own behalf, orthat use a business associate to transmithealth information in electronic form ontheir behalf, in connection with atransaction for which the Secretary hasadopted a standard (a coveredtransaction) are health care providerswho are required to comply with theHIPAA regulations.

The fact that a healthcare provider obtains an NPI does notimpose covered entity status on thathealth care provider.

Our general rule is that allhealth care providers, as we define thatterm in the regulations, will be eligibleto receive NPIs

National ProviderSystem (NPS)

HIPAA Administrative Simplification:Standard Unique Health Identifier forHealth Care Providers

Guidance on National Provider Identifier (NPI) Enumeration; 45 Code of Federal Regulations(CFR) § 162.412(b)

CMS ANNOUNCES THE STANDARD UNIQUE HEALTH IDENTIFIER FOR HEALTH CARE PROVIDERS FOR USE IN STANDARD TRANSACTIONS UNDER HIPAA

The Health Care Provider Taxonomy code

Center for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES)

This project uses the NPPES API to load data into a Mongo DB.

Load NPPES and Taxonomy data into PostgreSQl and Oracle

NPI_Search_MSSQL_PHP

NPPES CSV Import and Sanitation Project - PHP, Symfony4, MySQL

NPPES NPI + Postgres

Medicare Provider and Supplier Taxonomy Crosswalk

CROSSWALKMEDICARE PROVIDER/SUPPLIER to HEALTHCARE PROVIDER TAXONOM

If your taxonomy code is invalid or your taxonomy indicates you do not have the right to prescribe certain drugs, pharmacies using Express Scripts, Inc. (ESI)—our primary pharmacy network—will not fill your patients’ prescriptions.

The Complete History of the NPI Number The National Provider Identifier (NPI) is an under-appreciated marvel of the modern healthcare system.

NPI Fact SheetF o r H e a l t h C a r e P r o v i d e r sW h o A r e S o l e P r o p r i e t o r s

Part D plans must submit an electronic record, called a PDE record, toCMS for each covered prescription filled for their enrollees. CMSrequires that most PDE records contain an identifier for the drug’sprescriber. Acceptable prescriber identifiers include National ProviderIdentifiers (NPI), Drug Enforcement Administration (DEA) registrationnumbers, Unique Physician Identification Numbers (UPIN), and Statelicense numbers

US Department of Health and Human ServicesPrivacy Impact AssessmentDate Signed:12/22/2016OPDIV:CMSName:National Plan and Provider Enumeration System

National Standard Health CareProvider IdentifierAGENCY : Health Care FinancingAdministration (HCFA), HHS.ACTION: Proposed rule.SUMMARY : This rule proposes a standardfor a national health care provideridentifier and requirements concerningits use by health plans, health careclearinghouses, and health careproviders.

the same name andNational Provider Identifier (NPI) (asrequired to be reported in this final rule)should be used consistently for allpayment lines and any subsequentupdates for the same individual.

The name of the covered recipient.‘‘(ii) The business address of the covered recipientand, in the case of a covered recipient who is a physi-cian, the specialty and National Provider Identifierof the covered recipient.‘‘(iii) The amount of the payment or other transferof value.‘‘(iv) The dates on which the payment or othertransfer of value was provided to the covered recipient.‘‘(v) A description of the form of the payment orother transfer of value, indicated (as appropriate forall that apply) as—‘‘(I) cash or a cash equivalent;‘‘(II) in-kind items or services;‘‘(III) stock, a stock option, or any other owner-ship interest, dividend, profit, or other return oninvestment; or‘‘(IV) any other form of payment

Department of Health and Human ServicesOFFICE OFINSPECTOR GENERALMPROVEMENTS EEDED TOE NSURE P ROVIDERE NUMERATION AND MEDICAREENROLLMENT DATA AREACCURATE , C OMPLETE , ANDONSISTENTDaniel R. LevinsonInspector GeneralMay 2013OEI-07-09-00440I NC

Of the 10,504 locations reviewed, providers should not have been listed at 33.14% (3,481) of thelocations (2,088 + 1,393, as shown in Table 5) either because the provider did not work at thelocation or because the provider did not accept the plan at the location. In 1,393 of theseinstances, the provider should not have been listed at any of the locations in the directory. Therewere 690 phone numbers that were wrong or disconnected and 364 incorrect addresses. Finally,there were 221 instances in which the provider was found not to be accepting new patients,although the directory indicated that the provider was accepting new patients. Table 5 provides abreakdown of deficiencies identified by CMS during the review process.

In accordance with the NPPES Data DisseminationNotice (CMS-6060), published May 30, 2007, certain information that you furnish will be publicly disclosed. The NPPES DataDissemination Notice can be found at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/Downloads/NPPES_FOIA_Data-Elements_062007.pdf.

NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce theavailability of a new identifier for use in the standard electronic health care transactions.The National Provider Identifier (NPI) will be the single provider identifier, replacir1g thedifferent provider identifiers you currently use for each health plan with which you dobusiness.

The NCVHS has been briefed on theproposal for the National Provider Identifier(NPI), and we offer our strong support.

In the January 23, 2004 Federal Register (69 FR 3434), the U.S. Department of Health and Human Services (HHS) published a final rule establishing the standard for a unique health identifier for health care providers for use in the health care system and adopting the National Provider Identifier (NPI) as that standard (“2004 NPI final rule”). The rule also established the implementation specifications for obtaining and using the NPI. Since that time, pharmacies have encountered situations where they need to include the NPI of a prescribing health care provider in a pharmacy claim, but where the prescribing health care provider has been a noncovered health care provider who did not have an NPI because he or she was not required to obtain one. This situation has become particularly problematic in the Medicare Part D program. The addition to the NPI requirements addresses this issue.

SORN 09-70-0555 System Name: National Plan and Provider Enumeration System" (NPPES), HHS/CMS/OFM.

Privacy Act of 1974; System of Records A Notice by the Health and Human Services Department on 02/14/2018

Privacy Act of 1974; Report of a New Routine Use for Selected CMS Systems of Records A Notice by the Centers for Medicare & Medicaid Services on 05/29/2013

newsystem of records, called the ‘‘NationalProvider System (NPS),

modify or alter existing system of records titled “National Provider System,” System No. 09-70-0008

HIPAA Administrative Simplification: National Plan and Provider Enumeration System Data Dissemination

HIPAA Administrative Simplification: National Plan and Provider Enumeration System Data Dissemination

National Provider Identifier Standard (NPI): Educational Resources

Medicare NPI Implementation

National Plan and Provider Enumeration System (NPPES) Data Changes