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Applying for the NPI That’s Right for You

The NPI application process is quick and easy, but determining which kind of NPI to apply for is not as simple. How can you determine which one is right for you and your practice?

There are three basic types of NPIs available; individual, organizational and subparts. Individuals include dentists and dental hygienists. Organizations include group practices and clinics. Subpart NPIs are given to components of organizations, such as affiliated laboratories.

The trick is determining which type, or types, you need. All individuals who are required to or who want an NPI can and should apply for an individual NPI, otherwise known as Type 1. Other professionals may need an organizational NPI, or Type 2 identifier, as well. As a general guide:

   - If you report to the IRS using your individual name and your social security number, you need only       one individual (Type 1) NPI.
   - If you use a business name with a separate TaxID to report your earnings to the IRS, you need to       apply for an organizational NPI (Type 2) NPI as well.
   - When submitting claims, either paper or electronic, use your individual NPI for the rendering provider       in your claims and your organizational NPI for the billing NPI.

Subparts are not as common in dentistry as they are in other areas of health care such as hospitals, but are worth noting. A component of the same organizational entity, a subpart conducts its own standard transactions. Subparts apply to organizations, not individuals, and are not separate legal entities such as separate corporations. Covered organization health providers, such as hospitals, may be made up of components (e.g., an acute care hospital with an in-house dental program) that furnish health care, but are not themselves separate legal entities.

“It’s a good idea to take a look at the identification numbers you currently use,” said Janis Oshensky, vice president of professional relations for Delta Dental Plans Association. “A complete analysis and understanding of the identifiers you currently use and how they relate to your new NPI will help smooth the transition for your practice.”

For more guidance on the NPIs, go to the official government web site at http://www.cms.hhs.gov/NationalProvIdentStand/.

The information provided in this article is for educational and informational purposes only and should not be interpreted as legal advice. Dentists are encouraged to seek their own legal advice regarding the application of the National Provider Identifier Rule to their practices and circumstances.