What is the difference between NPI Type 1 and 2?
The National Provider Identifier (NPI) is an Administrative Simplification Standard under the Health Insurance Portability and Accountability Act (HIPAA). For covered health care facilities, the NPI is a unique identification number and use our NPI Registry Public Search Tool. In the administrative and financial transactions required by HIPAA, covered health care providers, all health plans, and health care clearinghouses must use NPIs. This ensures that the numbers don’t provide any additional detail about healthcare providers, such as where they live or what medical specialty they practice. In HIPAA standards transactions, the NPI must be used instead of legacy provider identifiers.
Covered insurers must also share their NPI with other providers, health plans, clearinghouses, and any agency that may require it for billing purposes, according to the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Types of NPI
There are two Types of NPI and these are as follow:-
Type 1 NPI
If you work as a solo practitioner and receive payment under your name or under your social security number, then you will be eligible for Type 1 NPI. For example, doctors, physicians, dentists, and all sole proprietors. An individual is eligible for only one NPI.
Type 2 NPI
Group practices, incorporated dental practices, and other business organizations paid under their business or corporate name, or under their employer identification number, are classified as Type 2 NPI. For example, physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself into a group practice.
If you’re a solo practitioner or individual doctor, you’ll need to start with a Type 1 NPI. Your unique NPI functions similarly to your social security number. It’s a unique identification number for you as a healthcare provider.
The difference between Type 1 and Type 2 NPI is that Type 1 is for individuals and Type 2 is for Group practices.