Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices 15581 

1https://nppes.cms.hhs.gov/#/. 

2The information collection request is currently 

approved under OMB control number 0938–0931. 

(https://www.reginfo.gov/public/do/ 

DownloadNOA?requestID=311118). 

3The Electronic File Interchange (EFI), also 

referred to as ‘‘bulk enumeration,’’ is a process by 

which a provider or group of providers can have an 

EFIO apply for NPIs on their behalf. EFIOs are 

approved by CMS through a certification process 

and submit information in a format designated by 

CMS; https://www.cms.gov/medicare/regulationsguidance/administrative-simplification/efi. 

following: NIOSH Program Update; 

Department of Labor Program Update; 

Department of Energy Program Update; 

SEC Petitions Update; Procedures 

Review Finalization/Document 

Approvals, Dose Reconstruction Review 

Methods and TBD 6000 Workgroup 

updates, Metals and Control Corp SEC 

Petition 236 (Attleboro, MA; January 

1968–March 1997), and a Board Work 

Session. Agenda items are subject to 

change as priorities dictate. 

The Director, Office of Strategic 

Business Initiatives, Office of the Chief 

Operating Officer, Centers for Disease 

Control and Prevention, has been 

delegated the authority to sign Federal 

Register notices pertaining to 

announcements of meetings and other 

committee management activities, for 

both the Centers for Disease Control and 

Prevention and the Agency for Toxic 

Substances and Disease Registry. 

Kalwant Smagh, 

Director, Office of Strategic Business 

Initiatives, Office of the Chief Operating 

Officer, Centers for Disease Control and 

Prevention. 

[FR Doc. 2024–04431 Filed 3–1–24; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–0059–N] 

RIN 0938–ZB82 

National Plan and Provider 

Enumeration System (NPPES) Data 

Changes 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS). 

ACTION: Notice. 

SUMMARY: This notice provides 

information on changes to data elements 

that providers are required to submit to 

the National Plan and Provider 

Enumeration System (NPPES) to obtain 

and maintain a National Provider 

Identifier (NPI). The changes to the 

required data elements affect the data 

that is made available to the public from 

NPPES in downloadable files and in a 

query-only database on the internet. 

DATES: This notice is applicable on 

April 3, 2024. 

FOR FURTHER INFORMATION CONTACT: 

Christopher S. Wilson, (410) 786–3178 

or Beth A. Karpiak, (312) 353–1351. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. Legislative and Regulatory 

Background 

Through subtitle F of title II of the 

Health Insurance Portability and 

Accountability Act of 1996 (HIPAA), 

Congress added Part C, ‘‘Administrative 

Simplification’’ to title XI of the Social 

Security Act (the Act). (Pub. L. 104– 

191). Part C of title XI consists of 

sections 1171 through 1179 of the Act. 

These sections define various terms and 

impose requirements on the Secretary of 

the Department of Health and Human 

Services (HHS) (hereinafter referred to 

as the Secretary), health plans, health 

care clearinghouses, and certain health 

care providers concerning the adoption 

of standards and implementation 

specifications relating to health 

information. The Secretary delegated 

authority for administering and 

enforcing HIPAA Administrative 

Simplification provisions related to 

transactions, code sets, unique 

identifiers, and operating rules, 

implemented in 45 CFR parts 160 and 

162, to the Centers for Medicare & 

Medicaid Services (CMS) (see 68 FR 

60694). 

Section 1173(b) of the Act requires the 

Secretary to adopt a standard unique 

health identifier for each individual, 

employer, health plan, and health care 

provider for use in the health care 

system and to specify the purposes for 

which the identifiers may be used. On 

May 7, 1998 (63 FR 25320), HHS 

proposed a standard unique health 

identifier for health care providers and 

requirements concerning its 

implementation (hereinafter referred to 

as the National Provider Identifier (NPI) 

proposed rule). On January 23, 2004 (69 

FR 3434), HHS published a final rule 

that adopted the NPI as the standard 

unique health identifier for health care 

providers (hereinafter referred to as the 

NPI final rule). The NPI final rule 

established that HIPAA covered entities 

must use NPIs to identify health care 

providers in electronic transactions for 

which the Secretary has adopted a 

standard. Covered entities include 

health plans, health care clearinghouses, 

and health care providers who transmit 

any health information in electronic 

form in connection with a transaction 

for which the Secretary has adopted a 

standard. 

B. Operational and System Background 

The NPI final rule established that 

NPIs are assigned to health care 

providers through the National Provider 

System (NPS). The preamble to the NPI 

final rule included an ‘‘NPS Data 

Elements Table’’ (69 FR 3457) that listed 

the data elements HHS expected to 

collect about a health care provider and 

include in the NPS. The NPS, now 

called the National Plan and Provider 

Enumeration System (NPPES),1

uniquely identifies health care 

providers through an application 

process and assigns NPIs. NPPES creates 

a record for each health care provider to 

whom it assigns an NPI. The records are 

updated when health care providers 

furnish updates to NPPES. 

Health care providers are categorized 

by NPPES into two types: Individuals, 

such as physicians; and organizations, 

such as hospitals. A health care 

provider may apply for an NPI in one 

of three ways, by: (1) completing form 

CMS–10114 (NPI Application/Update 

Form) and mailing it to NPPES; (2) 

applying online at https://NPPES.cms.

hhs.gov/; or (3) having an approved 

Electronic File Interchange Organization 

(EFIO) submit its NPI application data 

to NPPES in an electronic format 

defined by HHS.2 3 Health care 

providers who apply online have 

electronic access to the information in 

their own NPPES records by using user 

identifiers and passwords they select. 

This access allows those health care 

providers to submit updates to their 

NPPES data electronically via the 

internet. 

The NPI final rule requires that the 

NPS (now NPPES) disseminate data in 

response to approved requests. 

Following publication of the NPI final 

rule, CMS, as the administrator of 

NPPES, published a notice in the May 

30, 2007 Federal Register (72 FR 30011) 

describing the data dissemination 

strategy for NPI data maintained in 

NPPES and the process by which CMS 

would carry out the strategy (hereinafter 

referred to as the NPPES Data 

Dissemination notice). The NPPES Data 

Dissemination notice included a list of 

data elements that CMS determined are 

required to be disclosed under the 

Freedom of Information Act (FOIA) (see 

72 FR 30012). 

The health care industry needs 

NPPES health care provider data to 

know the NPIs of health care providers 

to be able to submit HIPAA-compliant 

health care transactions. In anticipation 


khammond on DSKJM1Z7X2PROD with NOTICES
15582 Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices 

4HIPAA Administrative Simplification: Standard 

Unique Health Identifier for Health Care Providers 

(NPI final rule) (69 FR 3455) https://www.federal

register.gov/documents/2004/01/23/04-1149/hipaaadministrative-simplification-standard-uniquehealth-identifier-for-health-care-providers#p-394. 

of an extraordinary demand from the 

health care industry for FOIAdisclosable NPPES health care provider 

data, in September 2007, CMS began 

making this information available to the 

public, in accordance with the 

Electronic Freedom of Information Act 

Amendments of 1996 (Pub. L. 104–231), 

via the internet in two forms: 

• NPI Registry: The NPI Registry is a 

query-only database that is updated 

daily to enable users to query NPPES 

(for example, search by NPI, provider 

name, etc.) and retrieve the FOIAdisclosable data from the search results. 

There is no charge to view the data. 

• NPI Downloadable File: Full 

Replacement Monthly NPI File, Weekly 

Incremental NPI File, and Full 

Replacement NPI Deactivation File. 

There is no charge to download the 

data. 

II. Provisions of the Notice 

A. Changes to NPPES Data Elements 

The NPI final rule acknowledged that 

the data elements and information 

presented in the data elements table 

were not intended to be used for data 

design purposes and that during the 

NPS design and development, the 

names and attributes of the data 

elements could be revised.4 The table 

was included to show the kind of 

information that CMS expected to 

collect about health care providers and 

that could be disseminated by the NPS 

(69 FR 3455). 

The data elements table in the NPI 

final rule included the following health 

care provider data elements addressed 

by this notice: provider first line address 

location, provider second line address 

location, and provider gender code. 

Thirty days after publication of this 

notice in the Federal Register, the 

NPPES system, NPPES Registry, paper 

form, and associated data files will be 

updated to begin collecting and 

disseminating for these health care 

provider data elements: (1) amend the 

description of the provider first line 

location address and second line 

location address data elements to permit 

a provider that does not have a physical 

location other than their home address 

to enter a United States Postal Service 

(USPS) post office box or personal 

mailbox provided by private delivery 

services as their provider location 

address; and (2) add additional choices 

for provider gender codes. All other 

attributes assigned to these data 

elements remain unchanged. 

The data elements relevant to this 

notice are listed in Table 1. Description 

of the information contained in each 

column of this table is as follows: 

• Data Element Name: The name of 

the data element residing in the NPPES. 

• Description: The definition of the 

data element and related information. 

• Data Status: The instruction for 

furnishing the information being 

requested in the data element. The 

abbreviations used in this column are as 

follows: 

++ Required (R): Required for NPI 

assignment. 

++ NPPES-generated (NG): Generated 

or assigned by the NPPES. 

++ Optional (O): Not required for NPI 

assignment. 

++ Situational (S): If a certain 

condition exists, the data element is 

required. Otherwise, it is not required. 

++ Repeat (RPT): Indicates that the 

data element is a repeating field. A 

repeating field is one that can 

accommodate more than one separate 

entry. Each separate entry must meet the 

edits, if any, designated for that data 

element. 

• Data Condition: Describes the 

condition(s) under which a 

‘‘Situational’’ data element must be 

furnished. NOTE: The abbreviation NA 

means ‘‘not applicable.’’ 

• Entity Types: The ‘‘Entity type 

codes’’ to which the data element 

applies. Code describing the type of 

health care provider that is being 

assigned an NPI. Codes are as follows: 

++ 1 = (Person): individual human 

being who furnishes health care. 

++ 2 = (Non-person): entity other 

than an individual human being that 

furnishes health care (for example, 

hospital, SNF, hospital subunit, 

pharmacy, or HMO). 

• Use: The purpose for which the 

information is being collected or will be 

used. The abbreviations used in this 

column are as follows: 

++ I: The data element supports the 

unique identification of a health care 

provider. 

++ A: The data element supports 

administrative implementation 

specification. 

TABLE A—NPPES DATA ELEMENTS AT ISSUE IN THIS NOTICE

Data element name Description Data 

status 

Data condition 

(situational status only) 

Entity 

types Use 

Provider first line location address.The first line location address of the provider being identified. For providers with more than one physical location, 

this is the primary location. This address can only include 

the USPS post office box location or personal mailbox offered by a private delivery service if the provider’s NPI is 

Entity type code = 1 and the provider does not have a 

physical location other than their home address (for example, a provider that exclusively provides telehealth 

services from their home).

R NA .......................................... 1, 2 ..... A 

Provider second line location address.The second line location address of the provider being 

identified. For providers with more than one physical location, this is the primary location. This address can only 

include a USPS post office box location or personal mailbox offered by a private delivery service if the provider’s 

NPI is Entity type code = 1 and the provider does not 

have a physical location other than their home address 

(for example a provider that exclusively provides telehealth services from their home).

S Required if it exists ................ 1, 2 ..... A 

Provider gender code ... The code designating the provider’s gender if the provider 

is a person.

S Required if the provider’s NPI 

is Entity type code = 1.

1 ......... I 


khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices 15583 

5HIPAA Administrative Simplification: Standard 

Unique Health Identifier for Health Care Providers 

(NPI final rule)(69 FR 3455) https://www.federal

register.gov/documents/2004/01/23/04-1149/hipaaadministrative-simplification-standard-uniquehealth-identifier-for-health-care-providers#p-394. 

6https://telehealth.hhs.gov/; https://

data.cms.gov/summary-statistics-on-use-andpayments/medicare-service-type-reports/medicaretelehealth-trends; https://www.ama-assn.org/ 

practice-management/digital/new-survey-datashows-doctors-steadfast-commitment-telehealth. 

1. Allowing Provider Address Location 

To Include Post Office Boxes 

The NPI final rule acknowledged that 

many comments to the NPI proposed 

rule noted that health care provider 

practice addresses change frequently, 

will be burdensome and expensive to 

maintain, and will be unlikely to be 

maintained accurately.5 In response to 

these comments, we concluded in the 

NPI final rule that, due to how 

frequently provider location addresses 

change, the data element is of limited 

use in electronic matching of health care 

providers (69 FR 3450). However, the 

rule did recognize that capturing one 

provider location address in NPPES 

could serve the administrative purpose 

of providing an address where a health 

care provider can be contacted in 

situations when a mailing address is 

insufficient. For example, a mailing 

address containing a USPS post office 

box number cannot be used for mail 

delivery by entities other than the 

USPS. The rule concluded that NPPES 

should collect a provider mailing 

address and one provider location 

address as required elements. To 

support this administrative purpose, 

both the provider first line location 

address and provider second line 

location address data element 

descriptions included a note indicating, 

‘‘This address cannot include a post 

office box’’ (69 FR 3458). 

Since the publication of the NPI final 

rule, health plans, Medicare, and 

Medicaid programs, have expanded 

coverage for telehealth services.6 As 

such, there are now a number of 

individual (Entity type code = 1) 

providers, such as behavioral health 

service providers, who exclusively 

furnish telehealth services from the 

providers’ homes. In some instances, 

providers who exclusively furnish 

telehealth services from their own 

homes may not have a provider address 

location other than their home address. 

We understand that providers who 

furnish telehealth services exclusively 

from their homes often enter a post 

office box as their provider mailing 

address into NPPES when applying for 

an NPI. Given the prohibition on 

including a post office box for the 

provider location address data elements, 

they enter their home addresses into 

NPPES to satisfy the provider location 

address data elements and obtain an 

NPI. 

In accordance with FOIA, NPPES 

address data, including provider 

mailing address and provider location 

address, is publicly available on the 

internet. Internet posting of provider 

home address information as a provider 

location may cause confusion, 

potentially leading patients and others 

who may access NPPES data to think 

that the provider can be accessed for 

treatment or administrative purposes at 

the listed home address. We have heard 

from providers that posting the 

information also poses privacy and 

potential safety concerns for themselves 

and their families. 

To address these concerns, while still 

maintaining the administrative purpose 

of providing a provider location address 

that can be accessed by methods other 

than the USPS when such a location 

exists outside of the provider’s own 

home, NPPES will keep the provider 

location address data element status as 

required, but will allow for submission 

of a post office box or personal mailbox 

offered by a private delivery service 

when a provider’s NPI is Entity type 

code = 1 and the provider does not have 

a physical location other than their 

home address (for example, a provider 

that exclusively furnishes telehealth 

services from their home). This change 

is accomplished by removing the 

language ‘‘This address cannot include 

a post office box’’ from the data element 

descriptions for both the provider first 

line location address and provider 

second line location address and 

replacing it with ‘‘This address can 

include a post office box or personal 

mailbox offered by a private delivery 

service only if the provider’s NPI is 

Entity type code = 1 and the provider 

does not have a physical location other 

than their home address (for example, a 

provider that exclusively provides 

telehealth services from their home).’’ 

The change in the data element 

descriptions allows providers that are 

persons that do not currently have an 

NPI, and exclusively furnish telehealth 

services or other services out of their 

homes, to obtain an NPI without 

including their home address in NPPES. 

Should a provider with Entity type code 

= 1 that has as an existing NPI, and 

exclusively furnishes telehealth services 

or other services out of their homes, 

wish to remove their home address from 

NPPES and replace it with a post office 

box, they may do so by updating their 

NPPES records, either themselves or 

through the EFIO that submitted their 

NPI application data to NPPES. The 

change in the data element descriptions 

does not require providers that already 

have an NPI assigned through NPPES, 

including telehealth providers that do 

not have a physical location address 

other than their home address, from 

changing any existing information in 

NPPES. Should a provider who 

furnishes telehealth services or other 

services exclusively from their home 

address wish to maintain their home 

address as their provider location 

address within their NPPES record, they 

may do so. 

2. Adding Additional Provider Gender 

Code Choices 

The NPI final rule identified provider 

gender code as a required data element 

if the provider’s NPI is Entity type code 

= 1. While neither the NPI final rule nor 

the NPPES Data Dissemination notice 

identified the gender codes that NPPES 

would collect and disseminate when 

applying for an NPI, providers are given 

the option to click on a box that 

captures gender as either male or 

female. NPPES stores that selection as 

code (F) should an individual select 

female and (M) should an individual 

select male. The NPI Registry queryonly database displays the descriptions 

‘‘Male’’ and ‘‘Female’’ to disseminate 

provider gender and NPI downloadable 

files display the information using the 

codes (M) and (F). 

NPPES will permit selection of, and 

disseminate, gender code options 

beyond M and F to promote improved 

accuracy in publicly available data and 

support unique identification and 

enumeration of health care providers. 

The NPPES system, NPPES Registry, 

paper form, and associated data files 

will be updated to begin collecting and 

disseminating these new values 30 days 

after publication of this notice in the 

Federal Register. NPPES will provide 

additional guidance on the new codes 

and instructions for selecting gender 

codes when applying for an NPI and 

maintaining NPI data. 

Adding gender codes aligns with HHS 

efforts, as described in E.O. 14075 (87 

FR 37189), to advance equity and full 

inclusion of lesbian, gay, bisexual, 

transgender, queer, and intersex 

(LGBTQI+) individuals through 

inclusive federal data collection 

practices. 

Providers with Entity type code = 1 

who previously furnished a provider 

gender code to NPPES may update or 

change their selection in NPPES, or 

have the EFIO that submitted their NPI 

application data to NPPES cause them 

to be changed in NPPES, at any time. 

HHS encourages providers who have 


khammond on DSKJM1Z7X2PROD with NOTICES
15584 Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices 

obtained NPIs to review their NPPES 

records to ensure that the information 

they furnished when applying for their 

NPIs is up-to-date and accurate. 

B. Impact on FOIA-Releasable NPPES 

Data 

The NPPES Data Dissemination notice 

identified both the provider location 

address and provider gender code as 

NPPES data elements that must be 

released under FOIA. The changes to 

these data elements described in section 

II. of this notice do not affect HHS’s 

assessment of their releasability under 

FOIA and the data elements will 

continue to be made available to the 

public through the NPI registry and the 

NPI downloadable files. 

III. Collection of Information 

Requirements 

This document imposes new 

information for collection and 

recordkeeping requirements. It makes 

reference to an existing information 

collection request that will be revised as 

a result of the revised data elements 

discussed in this notice. Specifically, 

we will submit a non-substantive 

change request to OMB for review and 

approval of the data element revisions 

associated with the information 

collection request currently approved 

under 0938–0931. 

Chiquita Brooks-LaSure, 

Administrator of the Centers for 

Medicare & Medicaid Services, 

approved this document on February 

27, 2024. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2024–04517 Filed 3–1–24; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Head Start REACH: 

Strengthening Outreach, Recruitment, 

and Engagement Approaches With 

Families—Mixed Methods Study (New 

Collection) 

AGENCY: Office of Planning, Research, 

and Evaluation, Administration for 

Children and Families, U.S. Department 

of Health and Human Services. 

ACTION: Request for public comments. 

SUMMARY: The Administration for 

Children and Families (ACF) within the 

U.S. Department of Health and Human 

Services (HHS) is proposing to collect 

data on different approaches that Head 

Start programs use to recruit, select, and 

enroll families, and the ways in which 

such practices reflect programs’ 

community contexts. We are not 

attempting to recruit a nationally 

representative sample. Instead, the 

study will aim to obtain a variety of 

eligibility, recruitment, selection, 

enrollment, and attendance (ERSEA) 

practices and experiences to explore 

how these practices and experiences 

intersect with different adversities, 

demographic characteristics, and 

community contexts. 

DATES: Comments due within 60 days of 

publication. In compliance with the 

requirements of the Paperwork 

Reduction Act of 1995, ACF is soliciting 

public comment on the specific aspects 

of the information collection described 

above. 

ADDRESSES: You can obtain copies of the 

proposed collection of information and 

submit comments by emailing OPREinfo

collection@acf.hhs.gov. Identify all 

requests by the title of the information 

collection. 

SUPPLEMENTARY INFORMATION: 

Description: Building on information 

collected previously through case 

studies (OMB #0970–0580), the Head 

Start REACH: Strengthening Outreach, 

Recruitment, and Engagement 

Approaches with Families Project is 

proposing to conduct a mixed-methods 

study to expand understanding of (1) 

how Head Start programs implement 

recruitment, selection, and enrollment 

practices; and (2) the ways in which 

practices reflect programs’ community 

contexts. The mixed-methods study 

would achieve several goals including 

(1) providing in-depth contextual 

information about recruitment, 

selection, and enrollment practices and 

experiences; (2) identifying promising 

recruitment, selection, and enrollment 

practices and experiences; and (3) 

informing training and technical 

assistance regarding recruitment, 

selection, and enrollment challenges 

and needs. We will aim to collect 

information from 60 Head Start and 

Early Head Start programs in 15 

geographic areas in states, from Head 

Start regions I–X, located in census 

tracts where the rate of deep poverty is 

high. 

We will collect information about the 

characteristics of families in Head Start 

programs and their communities; 

programs’ enrollment numbers and 

goals; programs’ use and perceived 

effectiveness of and challenges with 

recruitment, selection, and enrollment 

practices; promising recruitment, 

selection, and enrollment practices for 

potential future replication; families’ 

reasons for choosing Head Start and 

experiences with and perceptions of 

recruitment, selection, and enrollment 

practices; and how community partner 

staff support recruitment, selection, and 

enrollment of families into Head Start. 

The findings are intended to help Head 

Start programs understand how to 

support the needs of families facing 

adversities. We will disseminate 

findings in a report, research brief, and 

presentations or briefings. 

Respondents: Head Start program 

directors (one per program), ERSEA lead 

staff (one per program), Head Start 

parents/caregivers (up to 10 per 

program), and staff from community 

organizations with which Head Start 

programs partner for ERSEA activities 

(four in each geographic area). 

ANNUAL BURDEN ESTIMATES

Instrument 

Number of 

respondents 

(total over 

request period) 

Number of 

responses per 

respondent 

(total over 

request period) 

Average 

burden per 

response 

(in hours) 

Total/annual 

burden 

(in hours) 

Program director survey (Instrument 1) .......................................................... 60 1 0.17 10.2 

ERSEA lead staff survey (Instrument 2) ......................................................... 60 1 0.75 45 

Onsite coordination a ........................................................................................ 60 1 1.5 90 

Head Start parent/caregiver survey (Instrument 3) ......................................... 600 1 0.5 300 

Community partner survey (Instrument 4) ....................................................... 60 1 0.25 15 


khammond on DSKJM1Z7X2PROD with NOTICES