C.F.R. » Title 45 » SUBCHAPTER C—ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS › PART 162—ADMINISTRATIVE REQUIREMENTS › Subpart D—Standard Unique Health Identifier for Health Care Providers

45 C.F.R. § 162.410

Implementation specifications: Health care providers

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

(a) A covered entity that is a covered health care provider must:

(1) Obtain, by application if necessary, an NPI from the National Provider System (NPS) for itself or for any subpart of the covered entity that would be a covered health care provider if it were a separate legal entity. A covered entity may obtain an NPI for any other subpart that qualifies for the assignment of an NPI.

(2) Use the NPI it obtained from the NPS to identify itself on all standard transactions that it conducts where its health care provider identifier is required.

(3) Disclose its NPI, when requested, to any entity that needs the NPI to identify that covered health care provider in a standard transaction.

(4) Communicate to the NPS any changes in its required data elements in the NPS within 30 days of the change.

(5) If it uses one or more business associates to conduct standard transactions on its behalf, require its business associate(s) to use its NPI and other NPIs appropriately as required by the transactions that the business associate(s) conducts on its behalf.

(6) If it has been assigned NPIs for one or more subparts, comply with the requirements of paragraphs (a)(2) through (a)(5) of this section with respect to each of those NPIs.

(b) An organization covered health care provider that has as a member, employs, or contracts with, an individual health care provider who is not a covered entity and is a prescriber, must require such health care provider to—

(1) Obtain an NPI from the National Plan and Provider Enumeration System (NPPES); and

(2) To the extent the prescriber writes a prescription while acting within the scope of the prescriber's relationship with the organization, disclose the NPI upon request to any entity that needs it to identify the prescriber in a standard transaction.

(c) A health care provider that is not a covered entity may obtain, by application if necessary, an NPI from the NPS.

[69 FR 3468, Jan. 23, 2004, as amended at 77 FR 54719, Sept. 5, 2012]
Notes of Decisions
Cited in 4 cases, 2012–2017 · leading case: United States ex rel. Phalp v. Lincare Holdings, Inc., 116 F. Supp. 3d 1326 (S.D. Fla. 2015).
Sort: Relevance Newest Treatment
United States ex rel. Phalp v. Lincare Holdings, Inc., 116 F. Supp. 3d 1326 (S.D. Fla. 2015). · cites it 3× “45 C.F.R. § 162.410 (a)(1). The subpart enrollment requirement is echoed elsewhere in the.”
Zani v. Rite Aid Headquarters Corp., 246 F. Supp. 3d 835 (S.D.N.Y. 2017). “ownership or control.”))). Further, as Rite Aid points out, a business associate may “conduct standard transactions on .”
United States v. Alexander Popov, 742 F.3d 911 (9th Cir. 2014). “§ 1320d-2(b); 45 C.F.R. § 162.410 . Once enrolled, a Medicare service provider may submit claims for reimbursement for covered services.”
Ass'n of Am. Physicians & Surgeons, Inc. v. Sebelius, 901 F. Supp. 2d 19 (D.D.C. 2012). “45 C.F.R. § 162.410 (a). In addition, insurers — including Medicare — are required to use the NPI as the identifier for health care providers on all standard electronic transactions that require a health care provider identifier, 45 C.”
— 45 C.F.R. § 162.410(a)(1) — 1 case
United States ex rel. Phalp v. Lincare Holdings, Inc., 116 F. Supp. 3d 1326 (S.D. Fla. 2015). “45 C.F.R. § 162.410 (a)(1). The subpart enrollment requirement is echoed elsewhere in the.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.