NPPES Data Element Changes effective April 3, 2024

On March 4, 2024, the U.S. Department of Health & Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) published a notice in the Federal Register that clarifies changes to the data elements providers must submit to the National Plan and Provider Enumeration System (NPPES) to obtain and maintain a National Provider Identifier (NPI).

NPPES will now allow for submission of a post office box or personal mailbox offered by a private delivery service as a practice location address when the provider does not have a physical location other than their home address.

Additionally, the published changes permit selection and dissemination of gender values and gender code options beyond M and F (“X – Unspecified or another gender identity,” and “U – Undisclosed”) to promote improved accuracy in publicly available data and support unique identification and enumeration of health care providers. 

NPPES will be updated to begin collecting and disseminating these new values on April 3, 2024.

Who Must Get an NPI?

According to "If you are a HIPAA covered provider or if you are a health care  provider/ supplier who bills Medicare for your services, you need an NPI." further clarifies regarding HIPAA-covered entities: 

A HIPAA-covered entity is a:

  • Health care provider that conducts certain transactions in electronic form
  • Health care clearinghouse
  • Health plan (including commercial plans, Medicare, and Medicaid)
Under HIPAA, you’re a covered health care provider if you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so. 

How do I update my NPI record?

Instructions on how to update your NPI record can be found online at Changes may be made either online using your NPPES account, or by completing paper application/update form and submitting via postal mail to NPI Enumerator, 7125 Ambassador Rd. Ste 100 Windsor Mill, MD 21244

Share this post: