MeridianMERIDIAN

NPI (National Provider Identifier)

identity.medical.npi

10-digit numeric identifier for US healthcare providers, issued by CMS. Includes a Luhn check digit as the 10th digit. Required for HIPAA transactions. Format: exactly 10 digits. NPIs are issued with a first digit of 1 or 2; the CMS check-digit document reserves other first digits for use coordinated with the standard health plan identifier.

Casts to
VARCHAR
Check digit
Luhn with 80840 prefix

Shape

Pattern
^\d{10}$
ValueLengthShape
123456789310matches
100300012610matches
199278945710matches
1234567899rejected: one character short

Background

Origin

A final rule published in the Federal Register on January 23, 2004 adopted the National Provider Identifier (NPI) as the standard unique health identifier for health care providers.[1] The rule was issued by the Centers for Medicare & Medicaid Services, part of HHS.[1] It implements some of the requirements of the Administrative Simplification subtitle F of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).[1] Health care providers could apply for NPIs beginning on May 23, 2005.[1] Covered entities other than small health plans had to use the NPI in standard transactions no later than May 23, 2007.[1] Small health plans had until May 23, 2008.[1]

The May 7, 1998 proposed rule described the NPI as an 8-position alphanumeric identifier, with a numeric check digit in the 8th position.[1] That format was proposed to keep the identifier as short as possible while providing an identifier pool that would serve the industry's needs for a long time.[1] A strong majority of commenters recommended instead that the NPI be a 10-position numeric identifier.[1] Commenters who preferred a numeric identifier said it is more quickly and accurately keyed in data-entry applications.[1] The final rule made the NPI a 10-position numeric identifier, with the 10th position being an ISO standard check digit.[1] CMS estimated that 200 million NPIs would last approximately 200 years.[1] The rule says that if additional capacity is needed in the future, additional numeric digits will be added to the identifier.[1]

The NPI is an intelligence-free numeric identifier.[2] CMS reasoned that coded information about the provider in the identifier would mean issuing a new NPI any time that information changed.[1] The USA Registration Committee approved the NPI as an International Standards Organization card issuer identifier in August 1996 for use on standard health identification cards.[1]

Use

An NPI consists of 9 numeric digits followed by one numeric check digit.[3] The check digit is calculated using the Luhn formula for computing the modulus 10 double-add-double check digit.[3] When an NPI is used as a card issuer identifier on a standard health identification card, it is preceded by the prefix 80840.[3] In that prefix, 80 indicates health applications and 840 indicates the United States.[3] The check digit is always calculated as if the prefix is present.[3] In CMS's worked example, the 9-position identifier 123456789 gives the NPI 1234567893.[3]

CMS's specification says NPIs will initially be issued with the first digit 1 or 2, to avoid collisions with other card issuer identifiers.[3] Treat a leading 1 or 2 as a description of the numbers issued so far rather than a rule that can never change. (Meridian's view)

Under the rule, each health care provider may receive and use only one NPI.[1] An NPI is inactivated upon death or dissolution of the health care provider.[1] CMS notes that issuance of an NPI does not ensure or validate that the health care provider is licensed or credentialed.[4]

The NPI application form lets providers furnish other identifiers they hold, such as OSCAR, UPIN, DEA and Medicaid numbers.[1] Keep NPIs as text rather than integers, so the column keeps its fixed ten-digit width and nobody sums or averages it by accident. (Meridian's view)

Where you'll meet it

In September 2007, CMS began disclosing NPPES health care provider data that are disclosable under the Freedom of Information Act to the public.[5] The NPI Registry is a query-only database, updated daily, that can be searched by NPI or provider name.[5] CMS offers a Full Replacement Monthly NPI File, a Weekly Incremental NPI File and a Full Replacement NPI Deactivation File.[5]

CMS's Medicare Physician & Other Practitioners - by Provider and Service data identifies the rendering provider on the claim by NPI, in the Rndrng_NPI column.[6]

Sources

  1. [1]Federal Register, Volume 69 Issue 15 (Friday, January 23, 2004)standard
  2. [2]National Provider Identifier Standard (NPI)documentation
  3. [3]Requirements for National Provider Identifier (NPI) and NPI Check Digitdocumentation
  4. [4]NPI Filesdataset
  5. [5]Data Dissemination | CMSorganisation
  6. [6]Medicare Physician & Other Practitioners - by Provider and Service Data Dictionarydataset

Detection notes

NPI is a 10-digit identifier where the prefix 80840 is prepended for Luhn check digit calculation per the CMS algorithm.

Use it

CLI · DuckDB
$ finetype infer -i "1234567893" --mode column
→ identity.medical.npi

SELECT ft_infer('1234567893');
-- → 'identity.medical.npi'
Cast expression
CAST({col} AS VARCHAR)

Schema

https://meridian.online/schemas/identity.medical.npi · Frictionless type string

finetype taxonomy identity.medical.npi -o json-schema

Aliases

national_provider_identifierprovider_id

Type Registry