By: David Jensen, JD
Staff Attorney
September/October 2006
The Therapist
Updated August 2010 by David G. Jensen, JD CAMFT Staff Attorney
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In the last month or so, CAMFT has received inquiries concerning the National Provider Identifier ("NPI"). The NPI, which is one of the component parts of HIPAA, is an alphanumeric character that is assigned by the federal government to providers who are covered entities under HIPAA; providers who are not covered entities do not have to obtain NPIs, but they may do so, if they desire. Once assigned, the NPI identifies that particular provider when conducting electronic transactions, such as determining eligibility, submitting claims for reimbursement, or getting treatment authorized. Keep in mind that a provider can be an individual person, such as a licensee in private practice, or a partnership, a professional counseling corporation, or a nonprofit agency. Providers who are covered entities must get NPIs by May 23, 2007, although insurance companies are encouraging them to get NPIs now. Once enumerated, the provider's NPI will not change.

If you are a covered entity under HIPAA and you need to obtain an NPI, or if you are not a covered entity but you want to obtain an NPI, the NPI may be obtained on-line from the National Plan & Provider Enumeration System. To obtain the NPI on-line, go to https://nppes.cms.hhs.gov/NPPES/Welcome.do and click on the link for health care providers. The NPI may also be obtained by mail. To download a National Provider Identifier Application Form, go to www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/index.html.

The National Provider Identifier Application Form will request a Provider Taxonomy Code, which is used to classify the provider by license type. To speed completion of the Application Form, I have included the relevant taxonomy codes here. The taxonomy code for marriage and family therapists is 106H00000X; the taxonomy code for social workers is 104100000X; and the taxonomy code for psychologists is 103T00000X. For general information about HIPAA, including whether you are a covered entity, please visit the HIPAA section at www.camft.org.