Group NPI vs Individual NPI: 4 Easy Differences
A group NPI vs individual NPI question comes up the day a solo clinician forms an LLC or hires a second provider. The short answer: each clinician keeps one personal Type 1 NPI, and the practice can add a Type 2 NPI for the organization. This guide explains the four differences, using CMS and payer sources, for psychotherapists and psychiatrists.
Group NPI vs individual NPI: what each one is
An NPI is the number that identifies a health care provider on claims. CMS runs the system that assigns it, called NPPES. CMS says Type 1 is for individual providers, such as physicians, nurse practitioners and sole proprietors. Type 2 is for organizations, such as physician groups. In everyday billing, people say “group NPI” for the organization’s Type 2 number (see Group NPI) and “individual NPI” for the clinician’s own Type 1 number. The group NPI vs individual NPI choice is really a question of who the claim names.
Difference 1: who holds the number
You hold your Type 1 NPI as a person. Your practice entity holds a Type 2 NPI. CMS says an incorporated individual can have a Type 1 NPI for themselves and a Type 2 NPI for their corporation or LLC. A sole proprietor is not an incorporated individual, because no corporation has been formed.
Difference 2: how many you can have
CMS says an individual is eligible for only one Type 1 NPI. A sole proprietor gets one NPI regardless of how many locations they have or whether they have employees. Organizations can have multiple Type 2 NPIs. So when you compare group NPI vs individual NPI, remember that a clinician never needs a second personal number, even when joining a group.
Difference 3: what it ties to
CMS says a sole proprietor applies with a Social Security number, not an EIN, even if an EIN exists. A group NPI belongs to an organization that has its own tax ID. Payers match the two. Evernorth, for example, asks for a W-9 for each TIN and says the W-9 must match the TIN on your provider information form.
Difference 4: where it appears on a claim
A claim names a billing provider and often a rendering provider. In a group, the billing provider is usually the practice and the rendering provider is the clinician who saw the client. Each needs its own correct number. A mismatch between the NPI, name and tax ID on a claim and what the payer has on file is a classic reason for a rejection.
Do I need a group NPI?
It depends on how you practice. A solo clinician who bills as an individual can work with one Type 1 NPI. Forming an LLC or hiring clinicians usually means the practice needs a Type 2 NPI, and each clinician still keeps a Type 1. Evernorth treats a clinic as four or more independently licensed providers who share a TIN, a location and administrative staff, and it uses a separate application route for clinics. Aetna’s page tells individual providers to apply with a Type 1 NPI. Read the payer’s current instructions before you apply.
Keep NPPES current
CMS says covered providers must report changes to their NPI information within 30 days. Updating NPPES does not automatically update Medicare enrollment, so update both. Payers can also compare your NPPES record with your application, so keep addresses and taxonomy consistent.
Private payers, Medicare and Medicaid, and state rules
- Private payers: each plan sets its own rules for individual and group contracts, and some payers credential a group separately from its clinicians.
- Medicare and Medicaid: enrollment is separate from NPPES. Check CMS.gov and your state Medicaid agency for the current rules.
- State law: how you form an entity, and which professionals may own a practice, varies by state. Ask an attorney or your licensing board.
Therapists and psychiatrists: what differs
The NPI rules are the same for both. Psychiatrists who prescribe add a DEA registration, and Evernorth says prescribers need a DEA license for each location. A group that mixes therapists and prescribers should keep each clinician’s license, taxonomy and DEA information current. See adding a clinician to group credentialing and our credentialing page.
The short version
- Each clinician has one personal Type 1 NPI for life.
- A practice entity can add a Type 2 group NPI.
- The group NPI vs individual NPI split follows who bills and who treats.
- Match the NPI, name and tax ID to payer records, and report changes within 30 days.
- If you are opening a practice, start with start a private practice billing.
Sources checked (10/25/26)
- CMS, NPI fact sheet
- CMS, NPI fact sheet for sole proprietors
- Evernorth, join the behavioral network
- Aetna, join the network
Keep going
Related reading
Frequently asked questions
Can I use my individual NPI for my group practice?
Not as the group’s number. CMS says organizations get a Type 2 NPI, and an incorporated individual can hold a Type 1 for themselves and a Type 2 for the entity. Confirm what each payer expects on the application.
Does a sole proprietor need a group NPI?
CMS says a sole proprietor is eligible for one NPI, applied for with a Social Security number. A sole proprietor cannot be a subpart or designate subparts.
How soon must I update NPPES after a change?
CMS says covered providers must report changes within 30 days. Updating NPPES does not automatically update Medicare enrollment.
What is the difference in group NPI vs individual NPI on a claim?
The individual NPI names the clinician who rendered the service. The group NPI names the organization that bills. Payers match each to its tax ID and name.
