NPI Entity Type 1/Type 2 and Medicare Provider Numbers

Q.  If I am an incorporated physician, do I need two National Provider Identifiers (NPIs)?

A.  Yes. If you have a practice association (PA) or a limited liability corporation (LLC), and it holds any contracts with payers, or if payment is ever made to the PA or LLC, or in the name of the PA or LLC, then it needs to acquire a Type 2 NPI in addition to your individual Type 1 NPI.   

Even if the practice association is an S corporation or a "disregarded entity" (i.e., tax return can be filed in the physician's name), the above applies. From an NPI perspective, an S corporation is no different from a limited liability corporation or any other type of corporation; if the PA receives payments, it must have its own Type 2 NPI.

More information is available on these fact sheets from the Centers of Medicare & Medicaid Services:

Q.  If my practice has two NPI numbers, will I be issued two Medicare provider numbers as well?

A.  Yes, Medicare will issue two Medicare provider numbers to solo physicians who are incorporated (as a professional association or a limited liability corporation).

Q.  What if an incorporated physician submits a Medicare provider enrollment application with only one NPI number?

A. TrailBlazer Health Enterprises , the Texas Medicare Administrative Contractor, reports receiving many such applications. TrailBlazer will instruct the physician to obtain a second NPI so it can process the application.


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