What is NPPES? NPPES stands for the National Plan and Provider Enumeration System. The Center for Medicare and Medicaid Services (CMS) has contracted with Cognosante, L.L.C., to serve as the NPI Enumerator.
Organizations that are health care providers must obtain at least one NPI. Corporations are also eligible for subpart NPIs if they are needed to identify components of their business independently from the “parent” organization. If a corporation provides more than one provider type at the same physical location, an additional NPI will be required to identify the additional provider types separately.
How do I get my NPI? For the most efficient processing and receipt of NPIs, use the NPPES web-based application process. Simply log onto the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do and apply online.
Am I required to have an NPI for my provider type? Yes, unless you are an atypical provider according to NPPES criteria . Then your atypical provider identifier will be your WV Medicaid Provider ID number.
What about NPIs for different locations and different services. How do we register, can we use one NPI? If the different service locations all pay to the same Pay-To, separate NPIs are not required. If you want separate service locations to be their own Pay-To, they must enroll separately, and need to obtain separate NPIs. If you are a provider who has different provider types at the same location, each provider type will be enrolled separately, and need to obtain a separate NPI. You can access more information on subpart enumeration and separate NPIs at the National Plan & Provider Enumeration System (NPPES) at: https://nppes.cms.hhs.gov/NPPES/Welcome.do
Do we need a separate NPI for 2 provider types in the same location?
If you are a provider who has different provider types at the same location, each provider type will be enrolled with a separate Medicaid provider record, and needs to obtain a separate NPI.
I am an individual who is incorporated. Do I need a group NPI and what do I use as a Pay-To NPI? An incorporated individual should obtain a Type 2 Organizational NPI for the corporation in addition to the Type 1 Individual NPI. The Type 2 Organizational NPI will be used as the Pay-To NPI and the Type 1 Individual NPI will be used to enroll the provider in WV Medicaid as a rendering provider to the organization.
