Practice NPI Necessary?


(Lissa Lubinski) #1

Is our personal provider NPI adequate if we’re not billing Medicare (or other insurance)? I quickly ran it by Phil Eskew and he indicated that the provider NPI should typically suffice.


(Jason Larsen) #2

We have operating only under the provider NPI for ~4 years. Hasn’t been a problem so far!


(Robin Dickinson) #3

Yes, the practice NPI is really only necessary when dealing with insurance. I have it for billing Medicaid (I have a hybrid safety net DPC) but otherwise have always used my own NPI for things.


(Lissa Lubinski) #4

Thank you! This is helpful. I thought that was the case, then a doc (who was insurance based his whole life until last 4-5 years prior to retirement turned DPC) told me I needed one and I was surprised. But then on more digging realized he had it prior to DPC.


(Dr Brian Pierce) #5

Interestingly, I was just online at CMS yesterday checking this. I have a personal NPI, a pending one for the DPC practice (pending for two + years), and an old one from my insurance practice. The personal NPI shows me in PECOS and is the one I give out.

The lab we use says CMS told them my NPI is inactive as of 3/2016 (I opted out 4/1/2016) despite the CMS website showing my personal NPI as active.

I think CMS or their administrative company screw up periodically. We got the same call about six months ago and it went away without any action on our part.

Brian Pierce
Rockport, Maine


(Robin Dickinson) #6

Without a doubt!


(Cynthia Villacis) #7

Practice NPI is free to get. I was asked for it when applying for a few things - May have been able to get away with putting in personal NPI but wasn’t a big deal to get it. Think one was an application to do physicals for VES and the other was something medical that I wanted to buy.