Updates to National Plan and Provider Enumeration System (NPPES) Impact Physicians, Providers, and Suppliers

The Centers for Medicare & Medicaid Services (CMS) recently updated the National Plan and Provider Enumeration System (NPPES), which impacts all physicians, providers, and suppliers that use NPPES to obtain or maintain a National Provider Identifier (NPI) account. The NPI is a unique identifier for health care providers. To obtain an NPI, providers must submit an application within the NPPES. The changes to NPPES were implemented to streamline the NPI application process, enhance security, and provide an improved interface experience for users.

Within NPPES, there are two provider classifications: Type 1 and Type 2 providers. Type 1 providers are individuals, including physicians, dentists, and sole proprietors, who are eligible for one NPI number. Type 2 providers are organizations, including physician groups, hospitals, nursing homes, and corporations. Additionally, the NPPES houses “surrogates,” organizational providers or third-party organizations that have a business relationship with an individual provider or third-party organization to access, view, and modify information within the CMS computer system on behalf of the individual provider.

Under the updated NPPES, Type 1 and Type 2 providers are required to register for a CMS Identify & Access (I&A) Management System account in order to access NPPES. Once Type 1 providers have registered, surrogates will then be able to access their Type 1 provider’s NPI information and records. For type 2 providers, the NPPES changes are aimed at creating a more efficient and secure way for accessing NPI accounts. Prior to the most recent modifications to NPPES, users were required to create a unique login and password for each NPI, resulting in the sharing of login credentials between Type 2 providers and surrogates and increased security risks. Under the updated NPPES, Type 2 providers need I&A authentication credentials to access the system. The Authorized Officials and Delegated Officials within the I&A system can then access all NPIs under the Type 2 provider’s Employer Identification Number. This new and unified login method reduces security risks posed by the sharing of account information across providers. Other features of the new NPPES system include:

• Smart filters that only display entries that contain data entered by users, which helps to filter unnecessary information;
• Users can add more than one practice location to an existing NPI application;
• Taxonomy information can be completed on one page;
• Administrative users can update records on behalf of the provider;
• A new help option provides assistance to users based on the screen on which the user is working; and
• Users can save incomplete NPI applications and continue them when they return to the NPPES.

Physicians, providers, and suppliers should be aware of these new features and ensure NPPES accounts are updated with current authorized and delegated officials.