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What Is the Medicare Physician and Practitioner Look Up Tool?

what is the medicare physician and practitioner look up tool?

Using a practitioner look up tool to find a Medicare Provider Number is easy. The practitioner look up tool here on MedicareInsurance.com can help you quickly find a Medicare provider number for easy contact.

Just the Essentials:

  • As a Medicare beneficiary, you’ll receive an individual Medicare Provider Number. This number is also known as a Medicare Beneficiary Identification number, or MBI.

  • You can locate your Medicare Provider Number on your Medicare card.

  • Just as you have a Medicare Beneficiary Identification number (MBI), providers accepting Medicare assignment have Medicare Provider Numbers.

  • A provider’s Medicare Provider Number is assigned to them by the Centers for Medicare and Medicaid Services (CMS), the government agency that regulates Medicare.

  • In addition to a Medicare Provider Number, physicians who accept Medicare assignment must also have a National Provider Identifier, or NPI. This is a 10-digit number used to identify practitioners accepting Medicare assignment.

  • Wondering how to find the NPI for nearby practitioners? Our friendly licensed agents may be able to help.

Beneficiaries and Providers Both Have Unique IDs When it Comes to Medicare

If you’ve already gone through the Medicare process, you know all about your Medicare Beneficiary Identification number, or MBI. If you’re still new to Medicare, learning about the MBI is one of the most important things you’ll do on your journey. Your MBI is also known as your individual Medicare Provider Number.

If you’re already wondering how you get your MBI, it’ll be available on your Medicare card once you receive it. It also appears on paperwork you may receive from your local Social Security Administration (SSA) or Medicare offices.

Just as you receive an identification number when signing up for Medicare, healthcare providers receive an identification number when they begin accepting Medicare assignment. A healthcare provider accepting Medicare assignment receives what is known as their Medicare Provider Number. They must also receive what is known as a National Provider Identifier number, or NPI. The 10-digit NPI number can be used to find such providers when you conduct a Medicare provider number search.

Wait, let’s back up a second. Some of you may be wondering, “Who knew healthcare providers had Medicare identifiers?”. You may also be wondering how to find the NPI for healthcare providers near you.

That’s one of the very questions we’ll be tackling in this article. First, we’ll look at how physicians receive both their MPN and NPI numbers. Then, we’ll learn how you can find physicians and providers who accept Medicare assignment by using a physician and practitioner look up tool.

what is a practitioner look up tool?

Physicians: How to Get a Medicare Provider Number

If you’re a physician or a healthcare provider wishing to accept Medicare assignment, you are required to have a Medicare Provider Number. There are a number of steps you’ll need to follow in order to receive it. For physicians and providers who are curious, here’s how to get a Medicare Provider Number.

First, you’ll need to fill out a few forms. There are different forms to fill out depending on whether or not you’re a sole healthcare provider or if you operate a provider group. Here are the forms you’ll need to complete to get your Medicare Provider Number.

  • CMS-855I – for individual providers
  • CMS-855B – for practitioner groups and medical suppliers
  • CMS460 – A Medicare physician or supplier agreement
  • CMS588 – An Electronic Funds Transfer (EFT) authorization to pay for your number

In addition to your forms, you’ll need to provide the following documents:

  • A document to verify your business’ tax ID (CP575 or Letter 147C), both obtained from the IRS
  • A pre-printed voided check or bank letter with a business name that matches the one on your IRS CP575 or Letter 147C

Once you’ve completed and submitted the above, you should receive a Medicare Provider Number. In addition to your MPN, you’ll need to apply for what is known as a National Provider Identifier (NPI). To apply for this number, you’ll need to fill out the CMS-10114 form, which you can do online through the National Plan and Provider Enumeration System (NPPES). You can also find a PDF version of the form on the CMS website, which you can download, print, complete, and mail to the NPI Enumerator office.

how to use the practitioner look up tool?

Beneficiaries: How to Find the NPI for Participating Providers

If you are a beneficiary trying to figure out whether or not your healthcare provider accepts Medicare, there are numerous ways to find your answer. One of those ways is to search for them using what is known as a National Provider Identifier number, or NPI*.

Here’s how to find the NPI for physicians and practitioners in your area:

  • Search for them using the National Plan and Provider Enumeration System (NPPES)
  • Use an internet-based Medicare provider number database
  • Call a provider’s office and ask for their NPI number

Using this information, you’ll be able to easily discover whether or not the healthcare provider of your choice accepts Medicare assignment. How do you make that discovery? By using a physician and provider look up tool.

*Some sources may lead you to believe that an NPI is the same thing as a Medicare Provider Number. They are not the same thing, but an NPI can be used to identify physicians and practitioners who accept Medicare assignment.

Using a Physician and Practitioner Look Up Tool

In this digital age, it’s easier than ever to find healthcare providers who accept Medicare assignment. The easiest way to do this is to use a physician and practitioner look up tool, also called a “find a doctor” or “doctor lookup tool” colloquially from time to time. Major health insurance providers, such as Humana (Humana insurance company offer a brand name Humana health plan), include tools like this regularly to help beneficiaries find quality care and get a good public accounting of local healthcare industries, as do companies like ours!

Numerous sources, including CMS themselves, have made a practitioner look up tool available for beneficiaries seeking health care providers. In fact, we even offer a practitioner look up tool here on MedicareInsurance.com! Like other practitioner look up tools, ours is completely free to use, and makes public accounting of medical professionals and urgent care centers much easier. It’s also simple to navigate – if you don’t have a provider’s NPI number (whether it be a popular insurance provider like Humana insurance company, United HealthCare, or something else) all you need to do is enter their name and city, state, or zip. You’ll be learning whether or not your chosen healthcare provider accepts Medicare assignment (or if there are relevant exclusions) in no time.

If you haven’t yet enrolled in a Medicare health plan, or you’re nearing your age of enrollment, we can help you navigate the process with ease. Give our licensed agents a call today to learn more about Medicare health plan options available in your area.