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What is an NPI?



What it is, where to make it, how it's used.

For credentialing, everything begins with creating your NPI. As a provider, you will use your NPI as an ID to let the insurance world know who you are and where you want your payments to go.


An individual NPI, known as a type 1 NPI, is attached to the provider's SSN, so claims billed out under that NPI will be paid to the SSN.


A group NPI, known as a type 2 NPI, is attached to a practice's tax ID, and claims billed out under that NPI will be paid to the tax ID.


Your taxonomy will be what type of provider you are for an individual provider. If you are licensed as a nurse practitioner, then that's what your taxonomy will be. Do not choose a specialty if you are not licensed as such. It's equally important to note that if you were a generic provider (nurse practitioner) and then become certified as a specialist (Family Nurse Practitioner), you'll need to update your taxonomy to reflect that.


For group practices, please look at the descriptions of the taxonomies to ensure the one you choose accurately describes your practice. Do not choose a taxonomy because it "pays better" or because Timmy John down the road did, and he said it's right. As a provider/owner/representative of the practice, it's up to you to make legally educated and accurate choices for yourself and the group. If you are a multi-specialty group that provides a wide variety of services, you might choose General Practice. If you are a single specialty group with providers of one type, you can select that specific type (a group of all nurse practitioners would choose nurse practitioner taxonomy).


It's essential to keep your NPI updated with your current practice location and license information. Keeping your information updated is especially important when actively credentialing, as insurance companies check to ensure your information is current. 



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