> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Get NPIs (Type 1 and Type 2)

> NPPES walkthrough for individual and organizational NPIs, the dentist taxonomy family, subparts, and keeping NPPES current.

The **National Provider Identifier** is a 10-digit identifier used for healthcare providers in HIPAA standard transactions, including dental claims. CMS issues NPIs at no charge through **NPPES**, and the identifier does not expire. Each dentist needs a **Type 1** NPI. A professional entity generally needs a **Type 2** NPI when it is an organization healthcare provider.

## Prerequisites

* **Type 2:** the PC formed, with its EIN and the CP 575 letter in hand
* **Type 1:** the dentist's SSN, dental license, and credentials
* A CMS Identity & Access Management (I\&A) account

## Type 1, individual

**Check whether the dentist already has one first.** Type 1 NPIs follow the person for life, across every practice. A dentist who applies for a second creates a duplicate that causes claim rejections for years and is painful to deactivate. Search the [NPI Registry](https://npiregistry.cms.hhs.gov/) by name before applying.

Most dentists obtained theirs in dental school or a residency. If they genuinely don't have one:

<Steps>
  <Step title="Create an I&A account">
    At [nppes.cms.hhs.gov](https://nppes.cms.hhs.gov/), which authenticates through CMS I\&A.
  </Step>

  <Step title="Apply as an individual (Entity Type 1)">
    Legal name as it appears on the dental license, SSN, date of birth, license number and state, and practice location.
  </Step>

  <Step title="Select taxonomy">
    A code from the dentist family. See below.
  </Step>

  <Step title="Submit and wait">
    Typically days to two weeks.
  </Step>
</Steps>

## Type 2, organizational

<Steps>
  <Step title="Wait for the EIN">
    The application requires it. You cannot do this before formation completes.
  </Step>

  <Step title="Apply as an organization (Entity Type 2)">
    The **exact legal name from the CP 575**, EIN, practice location address, mailing address, and taxonomy.

    **The legal name is not cosmetic.** Payers match enrollment against IRS records. If the CP 575 says "MAYA OKAFOR DDS PC" and NPPES says "Bluebird Dental," you will spend months resolving mismatches across every payer. Use the IRS name in the legal name field and put the brand in "other name."
  </Step>

  <Step title="Name the authorized official">
    A person with legal authority to bind the entity. Given officer licensure rules in many states, this is usually the dentist-owner. Their credentials are required for future changes, so record who it is.
  </Step>

  <Step title="Select group taxonomy">
    The practice's dental taxonomy, or a group code where appropriate. See below.
  </Step>

  <Step title="Submit and wait">
    Typically a few days to two weeks.
  </Step>
</Steps>

## Taxonomy selection

A **taxonomy code** is a 10-character code identifying provider type, classification, and specialization, from the code set maintained by the National Uniform Claim Committee.<sup>1</sup>

Dentists live in the `1223` classification. The working set:

| Code         | Taxonomy                                          |
| ------------ | ------------------------------------------------- |
| `122300000X` | Dentist (unspecified)                             |
| `1223G0001X` | Dentist, General Practice                         |
| `1223P0221X` | Dentist, Pediatric Dentistry                      |
| `1223X0400X` | Dentist, Orthodontics and Dentofacial Orthopedics |
| `1223S0112X` | Dentist, Oral and Maxillofacial Surgery           |
| `1223E0200X` | Dentist, Endodontics                              |
| `1223P0300X` | Dentist, Periodontics                             |

Verify the code against the current NUCC set before registering because it updates twice a year. For a Type 2 NPI, a single-specialty dental practice may use its dental taxonomy or `193400000X` (Single Specialty Group). Use `193200000X` (Multi-Specialty Group) only when the entity actually includes multiple specialties. See [Provider taxonomy codes](/reference/edi/taxonomy-codes) for the working list.

Two checks prevent common enrollment mismatches:

1. **The taxonomy on the claim should match the payer's enrollment record.** A mismatch can cause an administrative rejection or denial even when the clinical information is correct.
2. **Group and individual taxonomies are different.** The Type 2 carries the group or practice taxonomy, while each Type 1 carries the dentist's individual taxonomy. A general dentist and an orthodontist may therefore have different codes while billing through the same Type 2.

<Note>
  🦷 Confirm the taxonomy under which each specialist is enrolled. Some payers use it when applying specialty fee schedules or claim edits, and medical plans may compare an oral surgeon's taxonomy with the submitted service. Use the current NUCC code that matches the specialty and payer enrollment.
</Note>

## Subparts

A Type 2 NPI can have **subparts**, additional organizational NPIs for distinct components with different locations or taxonomies.

Most single-location practices do not need one. Consider them when a payer requires location-level identification, or when one legal entity operates genuinely distinct service lines with different taxonomies.

<Tip>
  **Don't create subparts speculatively.** Each is another NPI to enroll with every payer, another set of EDI/ERA/EFT enrollments, and another thing to keep current. Create one when a payer requires it.
</Tip>

## Keeping NPPES current

NPPES data feeds payer directories and provider lookups. Stale information can cause claim rejections, incorrect patient searches, and payer-directory accuracy findings.

Update within 30 days of any change to:

* Practice location or mailing address
* Phone or fax
* Authorized official
* Taxonomy
* Legal name (e.g., after an entity name change)
* License information

Add an annual NPPES review to the compliance calendar.

## Verify it worked

* [ ] Dentist's existing Type 1 confirmed through the NPI Registry before creating another record
* [ ] Type 2 issued to the PC
* [ ] NPPES legal name matches the CP 575 **exactly**
* [ ] Taxonomies selected for both, and recorded
* [ ] Authorized official recorded, with their I\&A credentials retained by the organization
* [ ] Both NPIs verifiable in the public NPI Registry
* [ ] Annual NPPES review calendared

## Common failure modes

| Failure                                          | Consequence                                                  |
| ------------------------------------------------ | ------------------------------------------------------------ |
| Duplicate Type 1 created for an existing dentist | Years of intermittent claim rejections                       |
| Legal name in NPPES differs from the CP 575      | Payer enrollment rejections across the board                 |
| Wrong taxonomy                                   | Denials that look clinical but aren't                        |
| Specialist registered as general practice        | Specialty fee schedules and medical crossover claims at risk |
| Authorized official is someone who has left      | Cannot update the record                                     |
| Address never updated after a move               | Payer directory errors; missed correspondence                |
| Speculative subparts                             | Multiplied enrollment work for no benefit                    |

## Sources

1. National Uniform Claim Committee, [Health Care Provider Taxonomy](https://www.nucc.org/index.php/code-sets-mainmenu-41/provider-taxonomy-mainmenu-40). CMS, [NPI Standard](https://www.cms.gov/medicare/regulations-guidance/administrative-simplification/national-provider-identifier-standard).