Any “health care provider”:

• Both covered and non-covered providers
• Individuals: Physicians, dentists, nurses, chiropractors, others
• Organizations: Hospitals, ambulatory care facilities, laboratories, HMOs, group practices, others
• Subparts of providers

Covered Healthcare Provider Must:

• Must obtain an NPI for itself
• Must obtain an NPI for any subpart that would be a covered entity if it were a separate legal entity
• Must use the NPI to identify itself on all standard transactions
• Must disclose its NPI when requested in order to identity itself on standard transactions

What is a subpart?

• A provider that is a legal entity
• Subpart is not a legal entity but it furnishes health care
• Examples: Hospital unit, member of chain
• Concept does not necessarily correlate to hybrid entity, health care component, or organized health care arrangement
• Concept does not apply to individuals

Covered providers and subparts:

• Covered providers who are responsible for determining subpart’s need for NPI
• If need exists, a covered provider responsible for subpart obtaining NPI