Thursday, May 16, 2024

What’s My Medicare Provider Number

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How To Find ð? Your Medicare Provider Number ð PTAN

Select the button below to find and compare nursing homes, hospitals, doctors, and other health care providers in your area that accept Medicare. Get information like:

  • Quality ratings for local nursing homes and home health agencies
  • Estimate of doctors’ costs in your area
  • Dialysis facilities and hospitals near you
  • Contact information for local inpatient rehabilitation centers

Will My Npi Information Be Available To Others

CMS has created an online NPI registry where a physician, other health care provider, or organization can access NPI information. This is part of the same National Plan and Provider Enumeration System web site on which NPI registry is completed.Only the health care provider data elements that are disclosable under the Freedom of Information Act are released.

Information That Will Not Be Disclosed

Social Security Numbers , Internal Revenue Service Individual Taxpayer Identification Numbers and dates of birth are not disclosable under FOIA and, therefore, will not be released to the public.

More Information on NPI Dissemination

The CMS NPI Dissemination has more information regarding the disclosure of NPI information.

National Provider Identifier Standard

The National Provider Identifier is a Health Insurance Portability and Accountability Act Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier . This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 , covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

More detailed information is available on the pages listed in the left hand column of this page.

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How Do You Get Another Medicare Card

My card is lost or damaged Log into your Medicare account to print an official copy of your Medicare card. You can also call us at 1-800-MEDICARE to order a replacement card. TTY users can call 1-877-486-2048.

My name changed Your Medicare card shows the name you have on file with Social Security. Get details from Social Security if you legally changed your name.

Protect your identity

What Do I Do If I Lose My Medicare Card With My Number On It

Aetna Medical Id Card

If damaged, lost or stolen, you can request a new Medicare card from Social Security.

After your replacement request, the card typically arrives in the mail in about 30 days, at no cost to the beneficiary.

Social Security will mail your Medicare card to the address they have on file for you, so it is important to keep your information with them up to date.

You can update your address online using your my Social Security account.

If you need proof of your Medicare insurance sooner than the 30 days, Social Security can send you a letter stating your insurance status within 10 days.

Alternatively, you can get proof immediately by visiting your local Social Security office.

Find private Medicare providers who can help you manage all your health care needs enter your zip below for a free quotes comparison today!

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Access To Medicare Information By Healthcare Providers Or Representatives

Medicare information in your My Health Record is available to your healthcare providers involved in your care, unless you have added extra privacy controls.

You can decide whether nominated representatives can access your Medicare information by changing the access level of your Medicare information and your My Representatives settings.

Medicare Information Not Showing In Your My Health Record

Your Medicare information may be incomplete or unavailable. This may be because:

  • you have indicated that you do not want your Medicare information to be made available in your record
  • you have indicated that you do not want past PBS / RPBS and/or MBS / DVA information to be made available in your record
  • no PBS / RPBS and/or MBS / DVA information about you has been collected over the past 2 years.

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Provider Transaction Access Number

A PTAN is a Medicare-only number issued to providers by Medicare Administrative Contractors upon enrollment to Medicare. MACs issue an approval/notification letter, including PTAN information, when an enrollment is approved.

PTAN and NPI RelationshipWhile only the National Provider Identifier is submitted on claims, the PTAN is a critical number directly linked to a provider or supplier’s NPI. A PTAN’s use should generally be limited to a provider’s communication with their MAC.

Multiple PTANs for Different Practice Locations May be AppropriateNoridian may determine and issue more than one PTAN depending only upon the reasonable charge locality of your practice locations. Unless the reasonable charge locality changes, additional PTANs will not be assigned.

Provider Not Eligible for a Medicare PTANRequests for a “denial only letter” are no longer accepted. Providers that are not eligible for a Medicare number must have the beneficiary submit the CMS-1490S form.

Inactive PTANs are DeactivatedMedicare is mandated by CMS to deactivate PTANs not being used. The deactivation process occurs every month. A provider’s PTAN is deactivated when he or she has not billed the Medicare program for four consecutive quarters. A PTAN is given an end-date when it is deactivated, meaning claims can get submitted prior to the end-date within a year of the service date.

Find my PTANThere are two options to find a provider PTAN.

Ptan Lookup And Request Tool

Medicare Provider Enrollment Through PECOS

The Railroad Medicare PTAN Lookup and Request Tool is an online tool that allows providers to obtain their Railroad Medicare Provider Transaction Access Number or request a new Railroad Medicare PTAN. This tool replaces the “Request for Railroad Medicare PTAN for Electronic Submitters” form. You can access the tool at

Last Reviewed: 12/6/2021

To look up an existing Railroad Medicare PTAN for an individual provider or supplier , enter the following:

  • PTAN assigned to the individual provider or supplier by the local Part B MAC
  • Individual NPI
  • Last five digits of Tax Identification Number *

* If the provider is enrolled under a Social Security Number , please call our Provider Contact Center at 8883559165 for assistance. Choose option 3 for Provider Enrollment.

Look up an existing Railroad Medicare PTAN for a group/practice, enter the following:

  • PTAN* assigned to the group/practice by the local Part B MAC
  • Group/practice NPI
  • Last five digits of Tax Identification Number

* If the Railroad Medicare PTAN is linked to multiple NPI numbers, please call our Provider Contact Center at 8883559165 for assistance. Choose option 3 for Provider Enrollment.

If you are employed by a clearinghouse or third-party biller, you must contact the provider to obtain the PTAN.

Last Reviewed: 12/6/2021

The PTAN Lookup and Request Tool is currently not able to look up an existing Railroad Medicare PTAN in the following circumstances:

Last Reviewed: 12/6/2021

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What Is My Medicare Number

Your Medicare Number is the 11 digit code on the front of your red, white, and blue Medicare card that Medicare uses to identify you. To help keep your personal information safe, your Medicare Number is no longer the same as your Social Security Number. Your Medicare Number is a unique combination of 11 letters and numbers.

Medicare Secondary Payer Records In Cms’s Database

The BCRC is the sole authority to ensure the accuracy and integrity of the MSP information contained in CMS’s database ). Information received because of MSP data gathering and investigation is stored on the CWF. MSP data may be updated, as necessary, based on additional information received from external parties . Beneficiary, spouse and/or family member changes in employment, reporting of an accident, illness, or injury, Federal program coverage changes, or any other insurance coverage information should be reported directly to the BCRC. CMS also relies on providers and suppliers to ask their Medicare patients about the presence of other primary health care coverage, and to report this information when filing claims with the Medicare program.

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What Is The National Provider Identifier

The purpose of the National Provider Identifier is to uniquely identify a health care provider in standard transactions, such as health care claims.

NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities use NPIs in standard transactions. You are a covered entity if you conduct any electronic transaction with federal health programs.Your individual NPI is yours even if your employer files the application for it. The NPI does not change when you change practices or work in different settings. You will have only one individual NPI. It will be used by all health plans who are covered entities, eliminating what are likely many provider numbers assigned by Medicare, Medicaid, and private payers at present.

Coba Trading Partner Contact Information

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The Coordination of Benefits Agreement Program establishes a nationally standard contract between CMS and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data. CMS has provided a COBA Trading Partners customer service contact list as an avenue for providers to contact the trading partners. The COBA Trading Partners document in the Download section below provides a list of automatic crossover trading partners in production, their identification number, and customer contact name and number. For additional information, click the COBA Trading Partners link.

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What Is My Medicare Beneficiary Identification Number

Your Medicare Beneficiary Identifier number is for billing and identification purposes.

On a Medicare card received before 2015, your Medicare Claim Number consisted of your Social Security number followed by a code of letters and sometimes numbers that have a specific meaning.

In more recent years, a randomly-generated combination of letters and numbers replaced this Medicare Claim number.

Removing Social Security numbers from Medicare cards further protects the identities of Medicare beneficiaries. The replacement number is called the Medicare Beneficiary Identifier, or MBI number.

Moreover, if you still have a Medicare card with your Social Security number on it, you can still use it. Nonetheless, getting a new Medicare card is certainly in your best interest.

As you become Medicare savvy, see how much you can save on medical expenses by comparing Medicare insurance quotes for free with our free tool above! !

How Do I Get One

There is no charge to get an NPI. Audiologists and speech-language pathologists can apply online for their NPI, free of charge, by applying online or by contacting the NPI Enumerator to request a paper application. It takes less than 5 minutes to apply online and the number is issued within a few minutes. Note: The provider type is 23 . The taxonomy number for audiologist is 231H00000X. The taxonomy number for SLP is 235Z00000X.

Clinical Fellows without a state license are to apply for an NPI as a student. Under the NPI system, a student is defined as “An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration and/or licensure to provide health care.” When the state license is conferred, the applicant will need to update their taxonomy code. The student taxonomy code is 390200000X.

For further information about obtaining an NPI, please visit the NPI page on the CMS website.

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Termination And Deletion Of Msp Records In Cms’s Database

Medicare claims paying offices can terminate records on the CWF when the provider has received information that MSP no longer applies . Termination requests should be directed to your Medicare claims payment office. MSP records that you have identified as invalid are reported to the BCRC for investigation and deletion.

About Medicare Provider Numbers

PECOS Enrollment Tutorial â Revalidation for an Individual Provider

A Medicare provider number is a unique number you can get if youre an eligible health professional recognised for Medicare services. You need a provider number to claim, bill, refer or request Medicare services.

You must be registered with the Australian Health Regulation Agency or an approved registration body to apply for one.

Well always record your name on your provider number exactly as its registered with the relevant registration board or professional body.

Make sure you apply for one early. We get a high number of applications from December to April. During this time it can take a few weeks to get your provider number.

You cant access Medicare services until you have a provider number. You also cant use another health professionals provider number.

Youll need more than 1 Medicare provider number if you:

  • deliver health services in different locations
  • are registered in more than one health profession.

Find out how to apply for additional provider numbers.

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Not Sure What Type Of Provider You Need

Use our provider search tool to find quality data, services offered, and other information for these type of providers:

Nursing homes

Get detailed information about every Medicare-certified nursing home in the country. A nursing home is a place for people who cant be cared for at home and need 24-hour nursing care. Find nursing homes by location and compare the quality of care they give.


Find and compare hospitals that offer services like medical, surgical, and psychiatric care. Use the Hospital type” filter to find special facilities, like acute care, critical access, childrens hospitals, and more.

Doctors & clinicians

Find a doctor or clinician that accepts Medicare near you, or compare doctors who are qualified to practice in many specialties.

Home health services

Home health care describes a wide range of health care services that you can be get in your home at less expense than a hospital or skilled nursing facility. Compare home health agencies using the patient survey star ratings or the quality of patient care star rating.

Hospice care

Hospice agencies most often give services where you live, whether you’re at home, an assisted living facility, or a nursing home. Find hospices that serve your area and compare them based on the quality of care they give.

Inpatient rehabilitation facilities

Long-term care hospitals

Dialysis facilities

Medical supplies & equipment

Can You Look Up Npi Numbers

Find doctors / providers by The NPI number is a unique 10-digit identification number issued to covered health care providers by the CMS . Search the NPI database by NPI Number, first & last name, medical entity or group name.

What is the difference between NPI and Upin?

The NPI Directory also includes taxonomy codes that identify the type of provider . The UPIN Directory contains similar information for physicians who are enrolled in the Medicare Program, including full name, specialty, and practice location.

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What Is My Medicare Group Number

  • Your Medicare group number should be on your insurance card for your Medicare Advantage, Medicare Supplement or Part D plan. If you only have Original Medicare, you dont have a group number, but your 11-digit Medicare number is on your red, white and blue Medicare card.

You might look at your Medicare card and wonder where your group number is. Your red, white and blue card for Original Medicare does not include a group number.

Original Medicare is not a group policy, therefore there is no group in which to belong. Instead, you will see an 11-digit alphanumeric on your card which is used to identify you and file claims under your name. This is your Medicare number.

If you have a private Medicare insurance plan, however, you may potentially have a group number related to your policy, depending on your plan. You should check your insurance card for your private Medicare plan such as a Medicare Advantage plan, a Medicare Part D prescription drug plan or a Medicare Supplement plan to find your group number, if your plan assigned you one.

You can also contact your insurance company directly to find the information youre looking for.

Coordination Of Benefits Overview

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The Benefits Coordination & Recovery Center consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purpose of the COB program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payment. The BCRC does not process claims or claim-specific inquiries. The Medicare Administrative Contractors, , intermediaries, and carriers are responsible for processing claims submitted for primary or secondary payment and resolving situations where a provider receives a mistaken payment of Medicare benefits.

All Medicare Secondary Payer claims investigations are initiated from and researched by the BCRC, and is not a function of the local Medicare claims paying office. This single-source development approach greatly reduces the number of duplicate MSP investigations. This also offers a centralized, one-stop customer service approach for all MSP-related inquiries, including those seeking general MSP information. The BCRC provides customer service to all callers from any source, including, but not limited to, beneficiaries, attorneys/other beneficiary representatives, employers, insurers, providers, and suppliers.

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Check The Status Of Your Medicare Provider Number Now Or You May Loose Your Right To Prescribe Treatment And Services To Medicare Beneficiaries

Postedover 11 years agobyJon Brakefield

One-Time Mailing of Solicitation Letter to Physicians and Non-Physician Practitioners Who Are Currently Enrolled In Medicare But Who Do Not Have Enrollment Records In The Provider Enrollment, Chain and Ownership System

Physicians , physician assistants, certified clinical nurse specialists, nurse practitioners, clinical psychologists, certified nurse midwives, or clinical social workers should establish and update a record in the Medicare PECOS if they do not already have a record in that system. This article, based on CR 6842, advises you that your Medicare contractor will be mailing the letter shown in the attachment to CR 6842 if you do not have a record in PECOS. The letter will request that you take the steps to establish such a record and will explain how to do so. It is important that you maintain your enrollment information to ensure you are eligible for future Medicare initiatives and incentives.

The letter will explain that Medicare records indicate you do not have an enrollment record in PECOS because you enrolled in Medicare prior to implementation of PECOS and you have not submitted any updates or changes to your Medicare enrollment information in the past 6 years.

You should know that if you do not have an enrollment record in PECOS:

If you do not have a current and active Medicare enrollment record, it is imperative that you take the necessary action to establish your enrollment record as soon as possible.

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