NPI (National Provider Identifier)
Question:
In the case where NPI is unavailable, should that provider record be excluded? Is there a default value which should be sent?Answer:
If the provider does not have an NPI, in can be entered as {"NPI": null}. Null NPIs cannot be matched against the NPPES database and thus will not be included in the coverage data displayed on Healthcare.gov, but may be used by other developers leveraging this dataset.Question:
What NPI should be used for groups? For individuals?Answer:
NPI Type 1 should be used for individuals.NPI Type 2 should be used for groups and facilities.
For more information, see: https://npiregistry.cms.hhs.gov/
Individuals submitted with an organizational (group or facility) NPI will fail validation.
Groups/facilities submitted with an individual NPI will fail validation.
Please note: These above errors will not cause the rest of the file to be rejected - only the NPIs that fail validation will be rejected.
For more information about NPIs, visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/NPIBooklet.pdf
Question:
Our files received an error on NPI type, saying that the registry has the NPI as "unknown" - what does that mean?Answer:
An NPI that is marked 'unknown' is either not in NPPES, not currently in service, or deactivated. Please check NPPES at https://npiregistry.cms.hhs.gov/ for information about the specific NPI.___________________________________________________________________________________