What is the Difference Between an Individual NPI and a Group NPI?
What is the Difference Between an Individual NPI and a Group NPI?
Type 1 – Individual NPI
A Type 1 NPI is issued to individual healthcare providers, such as:
Physicians
Nurse Practitioners
Therapists
Chiropractors
Dentists
Each individual provider is required to have their own NPI, even if they work for a group or facility. This NPI is assigned to a person, not a business, and is used to identify the rendering provider on insurance claims.
Example:
Dr. Sarah Johnson, a family medicine physician, works for Oakwood Medical Group. Dr. Johnson must use her Type 1 NPI when she provides services and is listed as the rendering provider on claims.
Type 2 – Group or Organizational NPI
A Type 2 NPI is issued to healthcare organizations, such as:
Group practices
Hospitals
Laboratories
Ambulatory surgical centers
Home health agencies
This NPI is assigned to the business entity and used to identify the billing provider on insurance claims. If your practice is set up as a group (e.g., an LLC or corporation), the business will need a Type 2 NPI—even if there is only one provider in the group.
Example:
Oakwood Medical Group, where Dr. Johnson works, has a Type 2 NPI. This number is used as the billing provider on claims submitted to insurance companies.
When Both Are Required
Most insurance claims require both NPIs:
Rendering Provider NPI (Type 1): The individual who provided the service
Billing Provider NPI (Type 2): The group or entity submitting the claim and receiving payment
In Dr. Johnson’s case, her individual Type 1 NPI will be listed as the rendering provider, while Oakwood Medical Group’s Type 2 NPI will be the billing provider.
Key Takeaways
All individual health care providers need a Type 1 NPI, even if they work in a group setting.
Any group practice or organization that submits insurance claims must obtain a Type 2 NPI.
Both NPIs are often used together on claims: Type 1 for the person providing the care, and Type 2 for the entity billing for the care.
NPIs never expire and are not reassigned. Each provider and organization retains the same NPI for life.
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