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Which National Provider Identifier is Right for Your Practice?

The National Provider Identifier (NPI) is a 10-digit unique identifier that represents health care providers in HIPAA standard transactions. Dental providers are required to report an NPI number for all claims or verification of benefits, regardless of submission mode (i.e., electronic, mail, fax, etc.).

There are two types of NPIs:

1. Type 1 is for the provider. This is the only type of NPI you will need if you receive payments in your name or under your Social Security number as a solo practitioner. For practices with multiple dentists, obtain a Type 1 NPI for each dentist.

2. Type 2 is for group practices, incorporated dental practices or other business entities paid under their business or corporate name, or under their employer identification number (EIN).

On claims, the Type 2 NPI identifies the payee and may be submitted with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form, the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field 49. Use the chart below as a guide for determining if you need Type 1, Type 2 or both:

Need to apply for a Type 2 NPI? Apply online at the National Plan and Provider Enumeration System (NPPES) website.