No matter if you’re a surgeon, nurse, pharmacist, or massage therapist, you got into the profession because you want to help people. This can mean helping your patients fight disease, fix broken bones, make them more comfortable, or any one of thousands of other procedures health care providers perform. But before you can do any of that, you’ll need to fill out an NPI application form.

A National Provider Identifier (NPI) number is a unique number given to healthcare providers by the Centers for Medicare & Medicaid Services (CMS). Having an NPI is required to conduct electronic transactions within the healthcare system, including submitting claims to insurance companies and receiving payments electronically.

They need to be able to recognize the type of provider it’s from—whether a doctor, pharmacist, dentist, or optometrist—and identify the specific provider. Once the application is processed and approved, providers receive their unique NPI number, which will be used for all they use for all electronic transactions and communications within the industry.

How often do I need to fill out an NPI application form?

As a healthcare provider in the United States, you typically only need to fill out an NPI application form once in your career. It remains valid indefinitely, unless certain changes occur that require updates to your NPI record. If there are changes to any of that information (change of address, employer, etc.), you will need to make those edits as soon as possible.

You can report new or updated information to the National Plan and Provider Enumeration System (NPPES). Visit the NPI Enumerator website and from there, you’ll:

  • Log in or register if you haven’t already.
  • Find the option to manage or update your NPI.
  • Make the necessary changes to your personal and practice information.
  • Review everything to ensure it’s accurate.
  • Submit your updates.
  • Look for a confirmation message to ensure your changes were successful.

There are certain changes that can’t be made online, however. A paper NPI application/update form must be used for changing a birth date, social security number, or if you need to reactivate or deactivate an NPI. For more information, visit the NPPES website for help or give MBA Medical a call.

It’s also essential to safeguard your NPI and only share it with authorized entities and individuals when conducting healthcare transactions, such as medical coders and billers. If you suspect that your NPI has been compromised or misused, you should report it to the appropriate authorities and take steps to protect your identity and billing information.

Distressed doctor in front of a computer screen to illustrate what happens if I don't fill out an NPI application form.What happens if I don’t fill out an NPI application form?

The NPI serves as a unique identification number for healthcare providers and is a federal requirement for conducting certain healthcare transactions, including billing and claims processing. Without this number, you won’t be able to bill insurance, which means you might not get paid for your services.

Not to mention If you practice medicine without the right credentials, like an NPI, you could be breaking federal healthcare laws. This might mean fines, penalties, or even losing your medical license. You could also hurt your standing in the medical community: you may not be recognized as a legitimate provider, hurting credibility and trust with patients, colleagues, and other healthcare professionals.

What information do I need to fill out an NPI application form?

To properly fill out an NPI application form, you will need to provide various types of information related to your identity, professional credentials, and practice details. Here is a list of the key information typically required:

Personal Information:

  • Full legal name
  • Social Security Number (SSN) or Employer Identification Number (EIN)
  • Date of birth
  • Contact information (address, phone number, email)

Professional Credentials:

  • State license number(s) and expiration date(s)
  • Drug Enforcement Administration (DEA) registration number (if applicable)
  • Other professional certifications or credentials

Practice Information:

  • Name of practice or organization (if applicable)
  • Practice address(es) and contact information
  • Specialty or primary area of practice
  • Taxonomy code(s) representing your specialty or area of practice

Other Details:

  • Type of healthcare provider (individual, organization, or entity)
  • Practice ownership information (if applicable)
  • Relationship to other healthcare providers or organizations (if applicable)

Make sure you provide accurate and up-to-date information when you apply for an NPI number to avoid delays or complications in the processing of your application. Once completed, you can submit the form through the National Plan and Provider Enumeration System (NPPES) website or by mailing a paper version.

MBA Medical can help with all of your credentialing needs

As we said at the start, you became a healthcare provider to help people, not fill out paperwork. At MBA Medical, we offer top-notch credentialing services for both new and experienced healthcare providers. We handle everything from start to finish, ensuring all necessary documentation is submitted and approved.

From making calls to speaking with involved parties, submitting forms, and managing all the minute details—we’ve got it covered. The medical and health insurance fields are constantly evolving, making it challenging to stay updated. We’re here not only to help you stay current but also to assist you in getting ahead of the curve. Reach out for a consultation to see how we can help you and your practice stay on top of that industry paperwork.