Health Fitness Champion

Breaking Down an NPI Number Lookup Result

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When deciding between healthcare providers, each provider’s National Provider Identifier number is one factor that goes into your decision-making process.

An NPI number can help you determine whether your provider has the right qualifications and credentials to treat you effectively and safely.

This article will break down an NPI number lookup result to help you understand whether the provider you’re considering has what it takes to give you quality care.

What Is the NPI Number?

The National Provider Identifier (NPI) is a 10-digit number created by the Centers for Medicare and Medicaid Services in the United States. It uniquely identifies healthcare providers, including physicians, nurses, dentists, podiatrists, optometrists, and others.

Providers must have an NPI before submitting claims electronically to CMS or receiving payment from CMS. The goal of this system is to make it easier for providers to be identified and get paid faster.

An NPI number cannot be seen as being connected to a specific health provider; it’s just a string of numbers assigned to a person for healthcare administration purposes and can only be accessed by people who need it to do their job.

An NPI provides a direct link between all the information that providers need:

  • Their name
  • Their address
  • Their specialty
  • When they graduated from medical school, nursing school, etc.
  • What boards they’ve passed
  • What states license them

What Is An NPI Look-Up?

An NPI Look Up is an online service offered by most healthcare networks that allow patients to search for their provider’s contact information based on their NPI number. Patients use this service to learn more about their doctor’s credentials, location, and insurance benefits with their provider.

Because of privacy concerns, many healthcare networks limit patients to just a single NPI lookup per year. If you need more than one lookup during a year, call your provider’s office directly and ask them for their contact information. The NPI lookup results include the following:

  • The enumeration date– It’s the date that that organization was assigned a National Provider Identifier.
  • Endpoint information– provide a quick, secure, scalable, and standards-based way for participants to transmit authenticated, encrypted health information to well-known, reliable recipients via the Internet.
  • Taxonomy- A code indicates your categorization and area of expertise. You will utilize this code when requesting a National Provider Identifier, or NPI.
  • The address- the site of your business. It has three parts: street, city, and state. The street is usually listed first, followed by the town and then the state. Street names are sometimes abbreviated or spelled differently than they sound. For example, Ave or St can stand for Avenue and Street, respectively.

In Conclusion

NPI look-up results can be confusing and overwhelming at first glance. It is essential to break down the result so you know what to do with it. If the result has a Provider Status of VALID, then there are no issues with the number, and you should contact the provider directly if you need more information. If Provider Status says anything else, you should investigate whether or not this number is used by someone else.

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