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A Voice for Private Physicians Since 1943
Omnia pro aegroto

NPI Number Not Required to Opt Out of Medicare
Letter to Medicare Carrier and CMS

November 7, 2007

BY TELECOPY – 914-248-2867 AND CERTIFIED MAIL, RETURN RECEIPT REQUESTED

Attn: Lynn
Medicare Part B
Physician Participation
Empire Medicare Services
P.O. Box 1200
Crompond, NY 10517-1200

Re: K.L., M.D., Doc. Control # xxxxxxxx

Dear Madam,

I am the attorney for K.L., M.D., in this matter. Last week I left you a phone message about this matter but never received a call back.

K.L., M.D., has fully complied with the rules and regulations for opting out of Medicare. He does not have an NPI number and has no obligation to obtain one.

The statement by your office that Medicare will refuse to process his “opt out” without an NPI number is improper. The Federal Register fully recognizes that health care professionals need not obtain an NPI if they are not covered entities under HIPAA. “Health care providers that are not covered entities that do not wish to apply for NPIs will necessitate the need for health care clearinghouses to accommodate health care provider identifiers in addition to the NPI.” Federal Register, Vol. 69, No. 15, p. 3468. K.L. is not a covered entity and does not have an NPI or wish to obtain one.

Please confirm that you are processing Dr. K.L.’s opt out, without an NPI, as required by law. Thank you.

Sincerely,

Andrew Schlafly

cc: K.L., M.D.

Ms. Sandra M. Tokayer
Manager, Operation &Integrity Branch
CMS II Region Office
26 Federal Plaza
38th Floor, Rm 38-130
New York, NY 10278