As a healthcare provider or intending to open up a new practice, chances are you have come across the terms NPI 1 and NPI 2. These unique identifiers play an essential part in medical billing and credentialing. Yet, many providers struggle with understanding when to use either one of them. In this guide, we’ll outline some key differences between Individual NPI (Individual) and Organizational NPI (Organizational) for your NPI registration. We will also discuss our professional credentialing and enrollment services that can assist you in registering the appropriate NPI number(s).

What Is an NPI registration(National Provider Identifier)

Before diving deeper into its differences, let’s first define an NPI (National Provider Identifier). An NPI is a 10-digit identification number issued by the Centers for Medicare & Medicaid Services (CMS). It is necessary for healthcare providers and organizations to submit insurance claims or conduct HIPAA-compliant transactions.

There are two different types of NPI registration.

NPI 1 (Type 1 NPI) – Individual providers

NPI 2 (Type 2 NPI) – Intended to serve organizations and group practices

Each type serves its own specific function. Choosing the incorrect one can lead to claim rejections, enrollment delays, and compliance issues.

Who Should Get an NPI 1 (Type 1 NPI)?

A person requires an NPI 1 (Type 1 NPI) when:

Are You an Individual Healthcare Provider Billing Under Their Social Security Number (SSN)
As an independent solo practitioner without an organizational structure (such as an LLC, PLLC, or corporation) this may present particular challenges.
Your business structure does not allow for additional providers.
Are you an independent contractor or employer needing NPI credentials for insurance credentials? If yes, then an NPI number will help with insurance credentialing processes.

Providers Who Require an NPI 1:

Physicians (MD and DO), Nurse Practitioners (NP), Physician Assistants (PA), and Licensed Professional Counselors (LPC).
Physical Therapists (PT) and Occupational Therapists (OT)
Speech-Language Pathologists (SLPs)

Even if you later decide to open a group practice or form an LLC, your NPI 1 will remain permanently tied to you as an individual provider.

Who Needs an NPI 2 (Type 2 NPI)?

An NPI 2 is needed if any of the following apply:

Your business employs multiple healthcare providers.
Assuming you operate as a corporation, LLC, PLLC, or other legal entity and file taxes under an Employer Identification Number (EIN). Filing taxes is simple and straightforward.
Your plan is to submit claims under your business name rather than your personal identity.
Your organization would prefer that payments made for insurance be sent directly to them instead of you personally.

Example Organizations Requiring an NPI 2:

Group medical practices range from mental health clinics and physical therapy clinics to home healthcare agencies. They also include telehealth companies, urgent care centers, and chiropractic offices with multiple providers.

Type 2 NPIs allow businesses to collect payments and manage provider enrollments without associating everything to one specific individual’s personal information.

Can a Provider Hold Both NPI 1 and NPI 2 Credentials?

Why would healthcare professionals have both NPI 1 and NPI 2 numbers?

For various reasons:

If you own and manage a medical or therapy practice that requires an NPI 2, yet also see patients directly, an individual provider registration (NPI 1) will still be necessary.
Your National Provider Identification number 1 relates to the individual services you offer. On the other hand, NPI 2 represents any organization that employs other providers or bills under its own corporate name.
Insurance companies require both NPIs for group practices. One for the business itself and another for each provider working within its confines.

Example:

A nurse practitioner who runs their practice through an LLC while also seeing patients will require both an NPI 1 (for themselves as individual practitioners) and 2 (for their LLC).

An NPI 2 will be necessary when running their multi-location practice. However, they may still use NPI 1 when treating patients individually.

How Our Credentialing & Enrollment Services Can Assist in Securing an NPI 1 or NPI 2?

Navigating the NPI application and credentialing process can be time-consuming and cumbersome. This is why our expert team offers complete registration, credentialing, and insurance enrollment services to ensure your practice runs efficiently from day one.

How We Help with NPI 1 and NPI 2 Registration?:

Locate an NPI that Fits – We review your business structure and billing needs to help identify which NPI best meets them.
Submit and Process Your NPI Application – Our team manages the application process to avoid mistakes or delays.
Change Your NPI Information – Looking to change your business address, ownership details, or EIN? No worries; we specialize in updating NPI details too!
Enroll You with Insurance Providers – Our enrollment services ensure that your NPIs are correctly connected with payers like Medicare, Medicaid, and commercial insurers.
Avoid Costly Mistakes – Many providers are denied insurance credentials due to errors in NPI registration, which we work hard to prevent at the outset.

Let us handle the paperwork so you can focus on patient care!

Final Thoughts: Ensure your NPI registration Is Set Up Correctly

No matter if you are an independent healthcare practitioner, group practice owner, or starting up a healthcare startup, having the correct National Provider Identification Number (NPI) is key for billing insurance claims and credentialing purposes.

As an independent provider, if you require an NPI 1, this document must be filed.
if your business employs multiple providers, an NPI 2 may be necessary.
Many healthcare professionals need both for different billing purposes.

Don’t waste your time with confusing applications or credentialing errors! Contact us now, and let us handle the registration and enrollment of NPI and insurance plans smoothly!

Call us at (833) 477-1261
Email us at info@credexhealthcare.com
Visit Credex Healthcare to Get Started!

FAQs

Can I apply for both NPI 1 and 2 at once?
Absolutely – you can submit both applications concurrently if both will help your practice setup.

Do I require an NPI 2 as a sole proprietor?
No. Sole proprietors typically only require an NPI 1, unless forming an LLC or corporation.

How long will it take for me to receive an NPI?
Most NPIs are issued within two or three business days.

Can I change my NPI type later?
No. However, your business structure could require applying for an NPI 2 application instead.

Let us handle your NPI and credentialing needs so you can focus on expanding your practice!

(833) 477-1261

NPI 1 vs. NPI 2: Understanding the Differences and How Our Services Can Help