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Section IV - National Provider Identiﬁer (NPI) Number Deﬁnitions and Requirements
The National Provider Identiﬁer (NPI) is a federal requirement; however, atypical providers are not
required to have an NPI number. Atypical providers are individuals and organizations that furnish ‘atypical’
or non-traditional services that are indirectly health care related, such as taxi service, home and vehicle
modiﬁcations, habilitation and respite services.
Basis for NPI Number NPI Number Level of Information
C – Entity whose name is
on the W-9
Tax ID number and name ﬁled on the W-9: Legal owner of TIN - does not bill for medical services.
Indicate if it’s a Social Security number (SSN) or TIN.
D – Department
Department name: If the organization or sub-part was enumerated on the basis of a particular de-
partment, provide the Department Name that the NPI was based on, and designate this with a “D”
in the “Basis for NPI” ﬁeld. Insert the Department Name in the “Level Information” ﬁeld.
L – License
License number and state or state code: If the organization or sub-part was enumerated by
License, provide the state or state code and License Number that the NPI was based on, and des-
ignate this with an “L” in the “Basis for NPI” ﬁeld. Insert the License Number and state or state code
in the “Level Information” ﬁeld.
P – Place of service
Place of service address (street, city, state, ZIP+4) If the organization was enumerated by place of
service address, provide the street address that the NPI was based on and designate this with a
“P” in the “Basis for NPI” ﬁeld. Insert the Place of Service address in the “Level Information” ﬁeld.
List NPI number for each Group/Organization Place of Service
T – Tax ID number and
Tax ID number and Provider Name where care provider is not the same on the W-9, but bills with
this TIN. Indicate whether the Tax ID number is a SSN or TIN.
X – Taxonomy
NUCC Taxonomy Code: If the organization or sub-part was enumerated by a NUCC Taxonomy
code, provide the Taxonomy Code that the NPI was based on and designate this with an “X”
in the “Basis for NPI” ﬁeld. Place the NUCC Taxonomy Code in the “Level Information” ﬁeld.
O – Other
Any other basis for the NPI number: Provide any other basis for NPI number in the “Basis for
NPI Number” ﬁeld and designate as “O”, with a description of the basis for that NPI in the “Level
M – Name
Insert the name of the care provider (physician or allied health professional) in the “Level
Section V – Sign and Submit
Submit completed forms, required information and any additional rosters to firstname.lastname@example.org.
*Person completing this form:
*Telephone: ( ) *Office Contact:
Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company, Oxford Health
Insurance, Inc. or their aﬃliates. Health Plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA
UnitedHealthcare of California, UnitedHealthcare Beneﬁts Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare
of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, LLC, UnitedHealthcare Beneﬁts of Texas, Inc.,
UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans
(CT), Inc. or other aﬃliates. Administrative services provided by United HealthCare Services, Inc., OptumRx, OptumHealth Care
Solutions, LLC, Oxford Health Plans LLC or their aﬃliates. Behavioral health products are provided by U.S. Behavioral Health Plan,
California (USBHPC), United Behavioral Health (UBH) or its aﬃliates.