The Types of NPI Numbers

Our support center team frequently receives questions regarding National Provider Identifier (NPI) numbers. Our January/February 2015 issue of Insurance Solutions Newsletter featured an in-depth review of NPI numbers. Here are a few things to remember when reporting NPIs.

It is important to understand the two types of NPI numbers so that they can be properly reported on the claim form. The two types of NPI numbers are:

  • Type 1: Identifies an individual healthcare provider, such as a dentist.
  • Type 2: Identifies an organization or billing entity, such as a dental clinic, practice, corporation, hospital, or dental school.

An individual dentist who operates as a corporation must obtain both types of NPIs, one to identify the treating dentist and one for the practice (billing entity). If the dentist operates as a sole proprietor, the same NPI (a Type 1 NPI) may be reported for both the dentist and the billing entity. However, if the sole proprietor employs an associate dentist, many payers require that a Type 2 NPI number be obtained for the sole proprietor practice. This enables the payer to differentiate between the provider associate dentist and the owner of the practice.

When reporting NPIs on a dental claim form, be sure to enter the number in the correct box.

There are two fields on the 2012 ADA Dental Claim Form to report NPIs:

  • Box 54: Reports Type 1 NPIs.
  • Box 49: Reports Type 2 NPIs.

Also, the name that is associated with that NPI must be reported exactly as it is in the NPI records. This is true for both the treating dentist and the billing entity. Furthermore, if the two are the same, then they must match each other exactly on the claim form.

Example:

Dr. Robert Q. Dentist works at The Best Dental Practice. Dr. Dentist has a Type 1 NPI number. It should be reported in Box 54 of the dental claim form, along with his proper name, Robert Q. Dentist. If Bob Dentist or Robert Dentist is reported with his NPI, the claim could be rejected. Additionally, The Best Dental Practice has a Type 2 NPI, which should be reported in Box 49 of the dental claim form. Again, the proper name, The Best Dental Practice, should be entered on the claim. Any variation in this reporting could lead to a denial.

See the claim form below for a demonstration of this reporting.

The Types of NPI Numbers