NPI

National Provider Identifiers (NPIs) are required for all providers and practices enrolling with insurance—Type 1 for individuals, Type 2 for organizations.

What is an NPI?

An NPI (National Provider Identifier) is a unique 10-digit identification number assigned by the federal government to healthcare providers and organizations in the United States. It’s used by insurance companies, government payors, clearinghouses, and other healthcare systems to identify providers during claims submission and credentialing.

All providers and healthcare organizations must have an NPI to bill insurance or enroll with payors.

NPI Type 1 – Individual Providers

A Type 1 NPI is assigned to individual healthcare providers, such as doctors, nurse practitioners, licensed clinical social workers, therapists, and other solo professionals. This number is specific to the person and follows them throughout their career—even if they change jobs, tax IDs, or locations.

Examples of who needs a Type 1 NPI:

• Licensed therapists

• Physicians

• Nurse practitioners

• Chiropractors

• Physical and occupational therapists

Every credentialed provider must have their own Type 1 NPI, even if they’re part of a group.

NPI Type 2 – Organizations and Groups

A Type 2 NPI is assigned to healthcare organizations, group practices, and business entities. It represents the legal business—not the individual. This number is used to bill under the group’s name and Tax ID.

Examples of who needs a Type 2 NPI:

• Group medical practices

• Clinics or facilities

• Solo providers who formed an LLC, PLLC, or corporation

If your practice has a legal business name, EIN, and bills under that name, you need a Type 2 NPI—even if you're a solo provider.

Why Insurance Payors Require NPIs

NPIs help standardize provider identification across healthcare systems. Credentialing teams use them to:

• Match your applications to your identity and licensure

• Confirm you’re billing under the correct entity

• Distinguish between individual and group records

Incorrect or missing NPIs can delay credentialing, trigger rejections, or cause claims to be denied.

Where to Apply or Look Up Your NPI

• Apply for a new NPI or manage your record at the National Plan and Provider Enumeration System (NPPES)

• Look up an existing NPI at the NPI Registry

Best Practices for Credentialing

• Always list both your Type 1 and Type 2 NPI on credentialing forms if you're part of a group

• Make sure your NPI records are up to date with your current license, practice address, and taxonomy

• Confirm that the NPIs match what's listed on your W-9 and insurance applications

Need Help or Have a Question?

[email protected] 800-799-3859 piehealthusa.com