NHIC, Corp. UPIN Registry V6.1

	WHAT IS A UPIN?
	A UPIN is a six-position alphanumeric identifier that is assigned to all Medicare physicians, medical groups and non-physician practitioners
	WHY ARE UPINS ASSIGNED?
	Section 9202 of the Consolidated Omnibus Budget Reconciliation Act of 1985 required CMS to establish a unique identifier for each Medicare Part B medical group physician and non-physician-practitioner that is reimbursed by Medicare.
	WHAT IS THE DEFINITION OF PHYSICIAN?
	A physician as defined in 1861r of the Social Security Act, include medical doctors, doctors of osteopathy, doctor of dental medicine and dental surgery, optometry, podiatry, and chiropractic medicine.
	WHY ARE UPINS ASSIGNED TO NON-PHYSICIAN PRACTITIONERS?
	Effective January 1, 1998, Section 4511 and 4512 of the Balanced Budget Act of 1997 remove the restrictions on the type of areas and settings in which Medicare pays for the professional services of Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Physician Assistants (PAs), and Certified Nurse Midwives (CNM)
	WHY WAS THE WEB SITE DEVELOPED?
	Section 4164 of the Omnibus Budget Reconciliation Act of 1990 required CMS to develop a directory of UPINs. This web site will enable the health care community to identify and place the UPIN of the referring or ordering physician, NP, CNS or PA on the Medicare and other claim forms. Contact your local Medicare carrier for the coding and claim filing requirements.
	WHAT IS A PRACTICE SETTING?
	A practice setting is defined as a specific location at which a physician, medical group, or non-physician practitioner renders service. It is physically separate from any other location in which he or she renders service.
	WHAT IS A PROVIDER IDENTIFICATION NUMBER (PIN)?
	A PIN is the Provider Identification Number assigned by our local Medicare contractors also known as the Medicare billing number.
	WHY ARE THE PINs NO LONGER RELEASED?
	Due to the changing nature and format of the PINs and our concerns for accuracy, CMS is discontinuing reporting these numbers effective February 14, 2002
	WHAT TYPES OF PROVIDERS ARE REPORTED ON THE WEB SITE?
	MD = Medical Doctor DO = Doctor of Osteopathy OD = Doctor of Optometry DPM = Doctor of Podiatric Medicine DDM = Doctor of Dental Medicine DDS = Doctor of Dental Surgery CH* = Doctor of Chiropractic Medicine CNM = Certified Nurse Midwife CNS = Clinical Nurse Specialist NP = Nurse Practitioner PA = Physician Assistant GRP = Medical group ASC = Ambulatory Surgical Center AMB = Ambulance Service Supplier IDF = Independent Diagnostic Facility IPL = Independent Physiological Laboratories LAB = Clinical Lab –Billing Independent MSC = Mammography Screening Center PHS = Public Health Agency PXS = Portable X-ray Supplier * For UPIN Purposes, Doctors of Chiropractic Medicine are listed under the credentials of CH. The actual credentials are “DC”.
	WHAT INFORMATION IS PROVIDED ON THE WEB SITE?
	Group Name or Physician/Physician Practitioner – last, first, middle, and suffix Credentials - type of physician/non-physician practitioner; e.g., MD, DDS, PA, NP, CNS (See list of abbreviations above) UPIN - the unique number assigned to this physician/non-physician by the Registry State - the State for this practice setting ZIP code - the ZIP code for this practice setting Specialty - Specialties within Medicare are self-designated when enrolling with a Medicare carrier and may not be the same specialties for which providers are known in the community To request an electronic copy of the UPIN directory, please contact the local Medicare Part B carrier of jurisdiction. The U.S. Government Printing Office no longer has responsibility for the UPIN information
	WHAT SPECIALTIES ARE REPORTED ON THE UPIN WEB SITE?
	01- General Practice 02- General Surgery 03- Allergy/Immunology 04- Otolaryngology 05- Anesthesiology 06- Cardiology 07- Dermatology 08- Family Practice 09- Interventional Pain Management 10- Gastroenterology 11- Internal Medicine 12- Osteopathic Manipulative Therapy 13- Neurology 14- Neurosurgery 16- Obstetrics/Gynecology 18- Ophthalmology 19- Oral Surgery 20- Orthopedic Surgery 22- Pathology 24- Plastic and Reconstructive Surgery 25- Physical Medicine and Rehabilitation 26- Psychiatry 28- Colon Rectal Surgery 29- Pulmonary Disease 30- Diagnostic Radiology 33- Thoracic Surgery 34- Urology 35- Chiropractic 36- Nuclear Medicine 37- Pediatric Medicine 38- Geriatric Medicine 39- Nephrology 40- Hand Surgery 41- Optometry 42- Certified Nurse Midwife 44- Infectious Disease 45– Mammography Screening Center 46- Endocrinology 47– Independent Diagnostic Facility 48- Podiatry 49– Ambulatory Surgical Center 50- Nurse Practitioner 59– Ambulance Service Supplier 60– Public Health Agency 63– Portable X-ray Supplier 66- Rheumatology 69- Clinical Lab- billing independently 70- Multi-specialty Clinic or Group Practice 72- Pain Management 76- Peripheral Vascular Disease 77- Vascular Surgery 78- Cardiac Surgery 79- Addiction Medicine 81- Critical Care 82- Hematology 83- Hematology/Oncology 84- Preventive Medicine 85- Maxillofacial Surgery 86- Neuropsychiatry 89- Certified Clinical Nurse Specialist 90- Medical Oncology 91- Surgical Oncology 92- Radiation Oncology 93- Emergency Medicine 94- Interventional Radiology 95– Independent Physiological Laboratories 96- Optician 97- Physician Assistant 98- Gynecological Oncology 99- Unknown Physician Specialty
	HOW DOES A UPIN GET ASSIGNED?
	UPINs are assigned to physicians, non-physician practitioners and medical groups that bill Medicare Part B. When a provider applies for a Medicare billing number also known as a provider identification number in order to submit claims to Medicare Part B, the Medicare carrier submits a request for a UPIN via an electronic record to the UPIN Registry. The UPIN Registry processes the record, assigns the doctor a UPIN, and returns the record to the Medicare carrier.
	HOW CAN I FIND A PROVIDER IN MY AREA?
	There are numerous methods that can be used to search for a Physician, Non-Physician Practitioner, or medical Group on the UPIN Registry website. The user may input the specific UPIN of the individual if that is known. If the UPIN is not known, the website may be searched using the name information of the individual or medical group. The complete name information of the individual (last and first name) may be input, or the complete name of the medical group. The search may be conducted using the last name of an individual only, or the user may input as little as 2 characters of the last name (or medical group). In doing this, one must realize that the information returned from the search request will vary greatly depending upon what was input as the search criteria. We have upgraded the UPIN Registry website based on popular demand. You may limit or refine the scope of a search on the UPIN Registry website by inputting the appropriate selection criteria. Inputting a specific state will narrow the search to providers with office locations within the state selected. This is accomplished by clicking on the “State”” field which displays all 50 states, and each specific Medicare jurisdiction (i.e., Guam or the Virgin Islands). The user may also search for an individual by using a specific “credential” type or a specific zip code. This will yield only those individuals having that particular type of credentials or practicing within the specified zip code. If the user does not input any information in the name fields when requesting these types of searches, the website will return ALL providers practicing within the specific state, zip code or having that type of credential. If the name fields are used in conjunction with other criteria, the website will return all individuals with that name found within the other selection criteria.
	WHOM DO I CONTACT TO HAVE INFORMATION UPDATED ON THIS WEB SITE?
	Information appearing on the UPIN Registry website is drawn from each Medicare Part B carrier’s provider enrollment files. To correct or update information appearing on the Registry’s website, please contact the appropriate Medicare Part B carrier that has jurisdiction for the practice location. Follow these instructions to determine the appropriate carrier: On the UPIN Registry “Home” page, click on the related link “CMS Carrier Directory”. This will take the requestor to the Centers for Medicare & Medicaid website. A map of the United States and its territories will appear. Click on the state or territory where the practice is located. The CMS website provides information required to contact that carrier (i.e., mailing address, telephone number, email etc.)
	WHOM DO I CONTACT TO HAVE INFORMATION REMOVED FROM THIS WEB SITE?
	See above answer.
	HOW CAN I FIND OUT IF A PROVIDER HAS BEEN EXCLUDED FROM THE MEDICARE PROGRAM?
	You should contact your local Medicare Part B carrier to determine this type of information. You may also use the related link on the UPIN Registry’s website to go directly to the Office of the Inspector General (OIG) website. The OIG website allows a user to access their “Exclusions Database”. The OIG Exclusions Database lists all individuals and businesses that have been excluded from participating in federally funded health-care programs. Bases for exclusion include convictions for program-related fraud and patient abuse, licensing board actions and default on Health Education Assistance Loans.
	CAN WILD CARDS BE USED AS SEARCH CRITERIA?
	There is not any symbol that can be used as a wildcard when searching by name. To search by name, the user need only input a minimum of 2 characters into the last name field. It is not required to input any data into the first name field to use the search capabilities of the website.