A provider is an individual, group, or institution that delivers medical or health-related services to patients. This broad definition encompasses a range of professionals such as physicians, nurse practitioners, physical therapists, hospitals, and even entire healthcare systems.

A critical aspect of a provider’s identity in the United States is the National Provider Identifier (NPI). The NPI is a unique 10-digit identification number issued to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). It is used in administrative and financial transactions, such as billing, eligibility and claims, and is essential for the efficient coordination of healthcare services and the management of patient information across various healthcare platforms.

You can specify an NPI when creating a verification. Performing an eligibility request using an NPI that is not recognized by a payer will often result in an error.

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