Breaking Down an NPI Number Lookup Result

 

Breaking Down an NPI Number Lookup Result

The National Worker Identifier (NPI) is a unique 10-digit identification number assigned to healthcare providers and organizations in the United States. It serves a crucial role in the healthcare industry, facilitating the identification and tracking of healthcare providers, including physicians, hospitals, clinics, and more. When you perform an NPI number lookup, you receive a wealth of information that can be valuable for various purposes. In this article, we'll break down the components of an NPI number lookup result and explain their significance.

Understanding NPI Number Lookup

An NPI number lookup is a process of querying a database to retrieve information about a specific healthcare provider or organization using their NPI number. This lookup can be done through various online databases and tools, often provided by government agencies or third-party healthcare data providers.

Components of an NPI Number Lookup Result

When you conduct an NPI number lookup, you receive a detailed result that contains various pieces of information about the healthcare provider or organization associated with the NPI number. Let's examine the key components of an NPI number lookup result:

1. Basic Provider Information

The first section typically provides basic information about the healthcare provider or organization. This includes:

Provider Name: The full legal name of the healthcare provider or organization, including any suffixes like "MD" for medical doctors.

NPI Number: The unique 10-digit identifier assigned to the provider or organization.

Entity Type Code: A two-character code that indicates the type of healthcare provider or organization (e.g., individual, hospital, pharmacy).

Enumeration Date: The date when the NPI number was assigned.

2. Contact Information

This section provides contact details for the provider or organization, making it easier for patients and other healthcare professionals to get in touch. Common contact information includes:

Business Address: The physical address where the provider practices or the organization is located.

Phone Number: A contact phone number for inquiries and appointments.

Fax Number: If applicable, the fax number for sending documents or referrals.

Email Address: In some cases, an email address for electronic communication.

3. License Information

License information is crucial for verifying the provider's credentials and ensuring they are authorized to practice. This section typically includes:

State License Number: The provider's license number issued by the state licensing board.

State License Name: The name of the state where the provider is licensed to practice.

Healthcare Provider Primary Taxonomy: The primary specialty or field of practice, represented by a taxonomy code (e.g., Internal Medicine, Pediatrics).

4. Medicare and Medicaid Participation

Many healthcare providers participate in government healthcare programs like Medicare and Medicaid. This section indicates whether the provider or organization accepts these programs and the associated identifiers:

Medicare ID: The unique identifier for Medicare participation.

Medicaid ID: The unique identifier for Medicaid participation.

5. Other Identifiers

Healthcare providers may have additional identification numbers and codes associated with them, depending on their practice and affiliations. These identifiers can include:

Other Provider Identifiers: Any additional identification numbers used by the provider or organization.

Medicare UPIN (deprecated): The unique provider identification number used by Medicare before the adoption of NPI.

Medicare PIN (deprecated): The Medicare Provider Identification Number, which is no longer in use.

6. Healthcare Provider's Credentialing Information

Credentialing information helps verify a provider's qualifications and affiliations with healthcare organizations and institutions. This section may include details such as:

Credentialing Date: The date when the provider's credentials were last updated or verified.

Credentialing Status: Information about the provider's status, such as "Active" or "Inactive."

7. Enumeration at

The "Enumeration at" section provides information about where the provider or organization was enumerated, which is often the state where they obtained their NPI number.

8. Authorized Official Information

This section contains details about the authorized official responsible for the NPI record. This individual is typically associated with the provider or organization and may include:

Authorized Official Name: The full name of the authorized official.

Authorized Official Title or Position: The official's role or position within the organization.

Authorized Official Phone Number: Contact information for the authorized official.

Significance of NPI Number Lookup Results

NPI number lookup results are valuable for various stakeholders in the healthcare industry and beyond. Here's how different parties can benefit from the information provided in an NPI number lookup:

1. Patients

Patients can use NPI number lookup results to verify the credentials and contact information of healthcare providers. This helps patients make informed decisions when choosing a healthcare provider, ensuring they receive quality care.

2. Healthcare Professionals

Healthcare professionals, such as referring physicians, can use NPI number lookup results to confirm the credentials of other providers when making referrals or coordinating care. It ensures that patients receive appropriate and specialized care.

3. Healthcare Organizations

Hospitals, clinics, and healthcare organizations can use NPI number lookup results to verify the credentials of healthcare providers before granting them privileges or affiliating with them. This helps uphold the quality and safety of patient care.

4. Insurance Companies

Insurance companies may use NPI number lookup results to validate the participation of healthcare providers in their networks. It safeguards that claims are processed accurately and that patients have access to covered services.

5. Government Agencies

Government agencies, such as Medicare and Medicaid, rely on NPI number lookup results to verify the eligibility and credentials of providers participating in government healthcare programs. It helps prevent fraud and abuse.

6. Researchers and Analysts

Researchers and analysts in the healthcare field can use NPI number lookup results to gather data for studies, reports, and healthcare analytics. This information aids in understanding healthcare trends and improving healthcare delivery. Read More :- royalbeautyblog

Conclusion

An NPI number lookup result provides comprehensive information about a healthcare provider or organization, including their basic information, contact details, license information, and more. This data is critical for ensuring the quality and safety of healthcare services, verifying credentials, and making informed decisions in the healthcare industry. Whether you're a patient, healthcare professional, insurance company, or researcher, an NPI number lookup can be a valuable tool for accessing essential healthcare information.