Providers Enrolled as a ‘Sole Practitioner’, or ‘Private Practice’– Medicare Claim Submission Requirements for the Billing and Rendering Information

 

If a physician is are enrolled as a ‘Sole Practitioner’, or ‘Private Practice’ Provider, only the Billing NPI assigned should be submitted on the claim to Medicare. It is not required to also report an NPI as the Rendering Provider. Incorrectly reporting a Rendering Provider NPI that is not required, the system will automatically reject the claim based on the system editing for the Billing and Rendering information.

Please note that Organizational Groups who are enrolled are required to submit the Billing NPI and a Rendering NPI.

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