NPI Types: A Guide for Private Practice SLPs
You're feeling good- you are on the road to starting a private SLP practice and you have your ducks in a row.
You have your EIN and NPI, and you're credentialed with a few insurance plans.
You get ready to bill for your first insurance session- and see boxes 24J, 33A, and 33B on the CMS 1500 claim form. They all say "NPI" or "Identifier." What does it mean? Do you need to put the same number in each box?
Billing can be confusing, but I can help you figure out what the different types of NPI numbers are and what they mean.
An NPI number- short for National Provider Identifier- is basically an ID number. It is issued by the CMS (Centers for Medicare and Medicaid Services) to identify individual healthcare providers, and was created as part of HIPAA regulations.
It is specific to you, not the job you're in, so it stays the same whether you're in the schools, a medical facility, or a private practice.
To check if you have an NPI, visit the NPPES website. If you do not know how to log in, chances are that an employer set up your account for you. Just click the blue “Create or Manage an Account” button, then “Retrieve Forgotten User ID” and input your information. If your employer created the account, remember that they probably used THEIR phone number and zip code. If you can’t figure out what information was used, call the External User Services (EUS) helpdesk at 1-866-484-8049 and ask to retrieve your username that way.
What Type of NPI Do You Need?
If you are going to bill insurance - even indirectly by providing a superbill for clients to submit for Out of Network reimbursement- you DO need an NPI. So, which type of NPI do you need?
There are two types of NPI numbers:
Type 1: Individual/Personal NPI
Type 2: Organizational/Group NPI
In general, if you are a solo practitioner, you will just need a Type 1 NPI- UNLESS you have a single-member LLC/PLLC or other business structure and plan to accept Medicare.
In that case, you will also need to apply for a Type 2 NPI for your LLC- even though there is only one of you, an LLC is considered a "group/organization." For example, I have a Type 1 NPI for myself as a provider, Jill Shook, and a Type 2 NPI for my LLC, Jill Shook Therapy.
Confused about business structures? I explain them in this blog post
How to Apply for a Type 1 (Individual) NPI
Applying for a Type /Individual NPI is simple:
Sign in to the NPPES website
Click on Apply for an NPI for Myself on the top right
Enter your info, starting with your SSN
You do not need to enter language information
You do not need to fill out the Endpoint or Additional Identification pages, or enter your license number.
The Taxonomy page allows you to search.
If you are a licensed SLP, use 235Z00000X (Speech Language Pathologist)
If you are an SLP-A, use 2355S0801X (Specialist/Technologist- Speech-Language Assistant)
If you are a student, use 37020000X (Student in an Organized Health Education or Training Program)
Wait the 1-20 days it may take to be approved. It’s usually approved within minutes.
How to Apply for a Type 2 NPI
Applying for a Type 2 NPI is just as simple as applying for a Type 1:
Sign in to the NPPES website
Click on Apply for an NPI for an Organization (under the stock photo of a group of smiling providers)
Choose the “I Am An Employee” option in the popup that will appear (there is not an option for Owner) and enter your info, starting with your EIN.
You do not need to fill out the Endpoint or Additional Identification pages, or enter your license number.
The Taxonomy page allows you to search. You can use either 235Z00000X (Speech Language Pathologist) OR 261QH0700X (Clinic/Center- Hearing and Speech)
Wait the 1-20 days it may take to be approved. It’s usually approved within minutes.
How to Update Your NPI information
You can always update the information associated with your NPI at any time, such as after switching jobs or changing your name.
To do so, just
Log into the NPPES website
Scroll down and click on the pencil icon to the right of your NPI number. You will then be able to access all of the pages and update any information (address, contact information, etc)
Again, you do not need to fill out the Endpoint or Additional Identification pages, or enter your license number.
Where to Put Your NPI on the CMS 1500 form
So, now that you have those numbers, what do you do with them? You put them on your CMS 1500 claim forms and superbills, and they will be your unique identifier with any insurance company you are credentialed with. Until you have them memorized, write them down- I use the Important Business Info page from my Private Practice Foundations Course handbook.
When you are filling out the CMS 1500 form, your Type 1 (individual) NPI will go in box 24J- "Rendering Provider ID". This is the box for whomever actually rendered (provided) the service being billed.
Your Type 2 NPI will go in box 32A- "Service Facility Location Information", IF you have an LLC or other group business structure (partnership, S- or C-corp, etc). This even applies to single-member LLCs.
If you are a sole proprietor/solo practitioner and don't have an LLC or other business structure, you'll use your Type 1 NPI in this box. You use your private practice location address for this box, even if you see clients in their homes. This cannot be a PO box.
You can choose if you would like to use your Type 1 or Type 2 NPI in Box 33A- "Billing Provider Info"- if you have a Type 2, use that. If you don’t, use your Type 1. This box just tells the insurance company who the "pay to" person/organization is, so make sure all of the info is correct so they can get you your money.
If you want even more information, as well as a comparison chart of the business structures and more links to resources for SLPs, check out my step-by-step course, Private Practice Foundations. It has everything you need to start and maintain your private SLP practice, with links, resources, and videos!
Need help setting up your NPI? Set up a video consult with me so I can walk you through it!
