NRPM: Standard Health Care Provider Identifier. V. Data Dissemination

05/07/1998

We are making information from the NPS available so that the administrative simplification provisions of the law can be implemented smoothly and efficiently. In addition to the health care provider’s name and NPI, it is important to make available other information about the health care provider so that people with existing health care provider files can associate their health care providers with the appropriate NPIs. The data elements we are proposing to disseminate are the ones that our research has shown will be most beneficial in this matching process. The information needs to be disseminated to the widest possible audience because the NPIs would be used in a vast number of applications throughout the health care industry.

We propose to charge fees for the dissemination of such items as data files and directories, but the fees would not exceed the costs of the dissemination.

We would establish two levels of users of the data in the NPS for purposes of disseminating information. Some of the data that would be collected in order to assign NPIs would be confidential and not be disclosed to those without a legitimate right of access to the confidential data.

Level I - Enumerators

Access to the NPS would be limited to approved enumerators for the system that would be specifically listed in 45 CFR part 142. We would publish “routine uses” for the data concerning individuals in a Privacy Act systems of records notice. The notice is being developed and will be available during the comment period for this proposed rule.

Enumerators would have access to all data elements for all health care providers in order to accurately resolve potential duplicate situations (that is, the health care provider may already have been enumerated). Enumerators would be required to protect the privacy of the data in accordance with the Privacy Act.

Enumerators would have access to the on-line NPS and would also receive periodic batch update files from HCFA.

Level II - The public

The public (which includes individuals, health care providers, software vendors, health plans that are not enumerators, and health care clearinghouses) would have access to selected data elements.

The table below lists the data comprising the NPF, as described in section IV. A. Data Elements, and indicates the dissemination level (Level I or Level II).

Dissemination of Information from the National Provider File

Data Elements

Dissemination Level

Comments

National Provider Identifier (NPI)

I and II

8-position alpha-numeric NPI assigned by the NPS.

Provider’s current name

I and II

For Individuals only. Includes first, middle, and last names.

Provider’s other name

I and II

For Individuals only. Includes first, middle, and last names. Other names might include maiden and professional names.

Provider’s legal business name

I and II

For Groups and Organizations only.

Provider’s name suffix

I and II

For Individuals only. Includes Jr., Sr., II, III, IV, and V.

Provider’s credential designation

I and II

For Individuals only. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, PSY.

Provider’s Social Security Number (SSN)

I only

For Individuals only.

Provider’s Employer Identification Number (EIN)

I only

Employer Identification Number.

Provider’s birth date

I only

For Individuals only.

Provider’s birth State code

I only

For Individuals only.

Provider’s birth county name

I only

For Individuals only.

Provider’s birth country name

I only

For Individuals only.

Provider’s sex

I only

For Individuals only.

Provider’s race

I only

For Individuals only.

Provider’s date of death

I only

For Individuals only.

Provider’s mailing address

I and II

Includes 2 lines of street address, plus city, State, county, country, 5- or 9- position ZIP code.

Provider’s mailing address telephone number

I only

 

Provider’s mailing address fax number

I only

 

Provider’s mailing address e-mail address

I only

 

Resident/Intern code

I and II

For certain Individuals only.

Provider enumerate date

I and II

Date provider was enumerated (assigned an NPI). Assigned by the NPS.

Provider update date

I and II

Last date provider data was updated. Assigned by the NPS.

Establishing enumerator/agent number

I only

Identification number of the establishing enumerator.

Provider practice location identifier (location code)

I and II

2-position alpha-numeric code (location code) assigned by the NPS.

Provider practice location name

I and II

Title (e.g., “doing business as” name) of practice location.

Provider practice location address

I and II

Includes 2 lines of street address, plus city, State, county, country, 5- or 9- position ZIP code.

Provider’s practice location telephone number

I only

 

Provider’s practice location fax number

I only

 

Provider’s practice location e-mail address

I only

 

Provider classification

I and II

From Accredited Standards Committee X12N taxonomy. Includes type(s), classification(s), area(s) of specialization.

Provider certification code

I only

For certain Individuals only.

Provider certification (certificate) number

I only

For certain Individuals only.

Provider license number

I only

For certain Individuals only.

Provider license State

I only

For certain Individuals only.

School code

I only

For certain Individuals only.

School name

I only

For certain Individuals only.

School city, State, country

I only

For certain Individuals only.

School graduation year

I only

For certain Individuals only.

Other provider number type

I and II

Type of provider identification number also/formerly used by provider: UPIN, NSC, OSCAR, DEA, Medicaid State, PIN, Payer ID.

Other provider number

I and II

Other provider identification number also/formerly used by provider.

Group member name

I and II

For Groups only. Name of Individual member of group. Includes first, middle, and last names.

Group member name suffix

I and II

For Groups only. This is the Individual member’s name suffix. Includes Jr., Sr., II, III, IV, and V.

Organization type control code

I and II

For certain Organizations only. Includes Government - Federal (Military), Government - Federal (Veterans), Government - Federal (Other), Government - State/County, Government - Local, Government - Combined Control, Non-Government - Non-profit, Non-Government - For Profit, and Non- Government - Not for Profit.

Clearly, the access to the public data would have to be electronic in order to support the more frequent users. We are asking for comments on exactly what should be available in hardcopy, what types of electronic formats are necessary (for example, diskette, CD ROM, tape, cartridge, and via Internet), and frequency of update. We anticipate making these data as widely available as feasible. We note that the UPIN Directory (currently available to the public) would be discontinued and replaced with a similar document or electronic file once the NPS is in place.

We initially envisioned limiting access to the second level to health plans and other entities involved in electronic transactions and adding a third level of access, which would make a more abbreviated data set available to the general public. This was in keeping with the past policy of not disclosing physicians’ practice addresses. Recent court decisions and our broader goal of beneficiary education caused us to choose a broader data dissemination strategy. We welcome comments on this point.