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Single Member LLC- NPI Type Question

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James:
Hi everyone,

I have been reading quite a bit online about LLC's and NPI types and I just can't seem to figure out what to do for my situation. I was hoping someone could shed some light for me.

-I am a psychologist starting a private practice that will be out of pocket only (clients can submit to their insurance companies via a superbly).
-I have a single member LLC and an individual NPI number.
-I have read that I also need a type 2 NPI number but I am not sure if this is just for providers that accept insurance.
-I tried to go through the process of getting a type 2 NPI but was unsure what to put as the taxonomy as the only thing that resembled what I do is "Clinic/Center- Adult Mental Health" -I am not a clinic or center- I am an individual in private practice, so I am not sure if this is correct. Anyone have any idea?

Thanks for any help anyone can provide.

Best,

James

RichardP:
This is a question best answered by a healthcare attorney.

Having said that, here are some things to consider:

What follows in italics is the last paragraph of my first post at this link:

https://www.medicalbillinglive.com/members/index.php?topic=8882.msg29813#msg29813

The thing that trips people up is the distinction between sole proprietor (doing business in your own name, using your own SSN, having created no organization) and a sole practitioner or solo practitioner (having obtained an EIN, and doing business in the name of your organization).

After that paragraph, I provided a link - and that link no longer works.  I suggest you read through the thread I linked to above - several times if necessary - until you understand the general gist of what is being said.  And then read through the following two links.  They say the important parts of what the link-that-no-longer-works said.

Come back with questions as they develop.  But the primary take-away is that you only need 1 NPI number if your Taxpayer ID Number is your Social Security Number.  If your Taxpayer ID Number is the EIN of your LLC, then you must get a Type II NPI Number for your LLC, using the EIN of your LLC.

https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/Downloads/NPI_FactSheet_Sole_Prop_web.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/NPI-What-You-Need-To-KnowText-Only.pdf

RichardP:
A slightly different way of looking at the answer to your question is to pose a question that gets used quite often around here:

Who is the billing entity?

If the billing entity bills using its Social Security Number / reports its business tax using its Social Security Number, then they only need the Type 1 NPI Number.

If the billing entity bills using its Employer ID Number (EIN) / reports its business tax using its EIN, then they need a Type 2 NPI Number to go with their EIN.

Michele:
Richard gave some great information and based on what you are describing, if your patients will be submitting claims to their insurance, a type II NPI would be required for your LLC.

As for the taxonomy, you would pick "single specialty group" and then the appropriate taxonomy for psychologist.  Since there is only one practitioner (you) and you are a psychologist, you would select that for the group taxonomy.

James:
I really can't thank you all enough. I am so happy that I posted in this forum. You have answered my questions! I feel less frustrated now. Take care!

James

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