Individual NPI vs. Group NPI: What IBCLCs Need to Know
- Rachael Lara
- Jul 2
- 4 min read
One of the most common areas of confusion for new and growing IBCLC practices is the difference between an Individual NPI (Type 1) and a Group NPI (Type 2). Understanding when you need each—and how different insurance companies use them—can save you significant time and frustration during credentialing.
What Is an Individual (Type 1) NPI?
A Type 1 NPI identifies an individual healthcare provider. Every IBCLC who bills insurance should have their own Type 1 NPI.
This number follows you throughout your career, regardless of where you work or whether you change employers. It identifies you as the rendering provider who actually performed the service.
If you provide patient care, you need a Type 1 NPI.
What Is a Group (Type 2) NPI?
A Type 2 NPI identifies a business entity rather than an individual provider.
This may include:
Sole proprietorships
LLCs
Professional corporations
Partnerships
Other legal business entities
Contrary to what many providers believe, a Group NPI is not reserved for large practices. Even a solo practice may need a Type 2 NPI depending on the insurance company you plan to contract with.
Do Solo IBCLC Practices Need a Group NPI?
In many cases, yes.
While many providers assume a Group NPI is only necessary after hiring additional clinicians, several commercial insurers require a Type 2 NPI as part of their contracting process, even for a one-provider practice.
If you plan to credential with multiple insurance companies, obtaining both your Type 1 and Type 2 NPI early can prevent delays later.
Why We Recommend Getting a Group NPI Early
A Type 2 (Group) NPI is completely free to obtain, the application typically takes only a few minutes to complete through the National Plan and Provider Enumeration System (NPPES), and there is essentially no downside to having one before an insurance company requires it.
Many IBCLCs wait until a payer asks for a Group NPI, only to discover they must pause the credentialing process while they apply for one. Obtaining your Type 2 NPI as part of your initial business setup helps avoid unnecessary delays and makes future credentialing much smoother.
Even if you never need it immediately, having a Group NPI provides flexibility as your practice grows. Whether you add another provider, expand into a group practice, or contract with a payer that requires a Type 2 NPI, you'll already have this important step completed.
Because it is free, easy to obtain, and carries virtually no downside, we generally recommend that every IBCLC practice obtain a Type 2 NPI early in the business formation process.
How Major Insurance Companies Typically View Group NPIs
Although policies can change over time and may vary by state or contract, these are common requirements we encounter during the credentialing process for IBCLC practices.
Cigna
Cigna generally expects providers to contract through a Type 2 (Group) NPI, regardless of practice size.
Even individual IBCLC practices often require a Group NPI to finalize the contracting process. This is because Cigna contracts IBCLCs solely as ancillary providers, listing them only as a group, and never including their individual type 1 NPI.
UnitedHealthcare (UHC)
UnitedHealthcare typically allows solo providers to contract individually.
However, once your practice includes two or more providers, UHC generally expects the practice to establish a Group NPI and complete group credentialing.
Aetna
Aetna generally considers a practice eligible for group contracting when there are three or more providers.
Practices that grow beyond a solo or two-provider model should be prepared to complete both individual provider applications and a separate group application.
Blue Cross Blue Shield (BCBS)
Blue Cross Blue Shield requirements vary significantly because each BCBS company operates independently.
Many BCBS plans do not recognize a practice as a group until it has approximately four providers, while others may require even more before offering a group contract. In some states, the threshold may be lower, while in others it may be higher.
Always verify the requirements with your state's BCBS plan before beginning the application process.
Why This Matters
Choosing the wrong credentialing path can delay your approval by weeks or even months.
Common mistakes include:
Applying as an individual when the payer expects a group application.
Waiting until you've hired additional providers before obtaining a Type 2 NPI.
Assuming every insurance company follows the same credentialing rules.
Delaying your Type 2 NPI application because you believe you're "too small" to need one.
Each payer has its own credentialing policies, and they often differ substantially.
Type 1 vs. Type 2 NPI at a Glance
Type 1 NPI | Type 2 NPI |
Identifies an individual provider | Identifies the business entity |
Stays with you throughout your career | Belongs to the practice |
Used as the rendering provider | Used as the billing/group provider |
Required for every IBCLC providing care | Frequently required for commercial insurance contracting |
One per individual | One per legal business entity |
Final Thoughts
Understanding the difference between your Individual and Group NPI is one of the first building blocks of successful insurance credentialing.
Our recommendation is simple: every IBCLC should obtain a Type 1 NPI, and every IBCLC practice should strongly consider obtaining a Type 2 NPI during the initial business setup process. Since a Group NPI is free, easy to obtain, and commonly required by commercial insurers, there's little reason to wait until a payer asks for it.
Keep in mind that insurance company policies can change and may differ by state, product line, or contract type. Before submitting credentialing applications, always verify current requirements with the payer or work with an experienced credentialing specialist familiar with IBCLC contracting.
At SunShyn Credentialing, we help IBCLCs navigate payer-specific credentialing requirements every day, ensuring applications are submitted correctly the first time so you can spend less time on paperwork and more time caring for families.
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