diff --git a/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/5_4_0/2590-preserve-the-ID-value-of-the-resources-in-the-package-loader.yaml b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/5_4_0/2590-preserve-the-ID-value-of-the-resources-in-the-package-loader.yaml
new file mode 100644
index 00000000000..239cc70a772
--- /dev/null
+++ b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/5_4_0/2590-preserve-the-ID-value-of-the-resources-in-the-package-loader.yaml
@@ -0,0 +1,5 @@
+---
+type: add
+issue: 2590
+title: "When resources are created using package load, the new resources will use the same IDs as were provided in with the resource definitions in the package, if they exist.
+If the ids are numeric, a prefix of 'npm-' will be added."
diff --git a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/packages/PackageInstallerSvcImpl.java b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/packages/PackageInstallerSvcImpl.java
index 7c044f667db..d3d3bbda7f3 100644
--- a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/packages/PackageInstallerSvcImpl.java
+++ b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/packages/PackageInstallerSvcImpl.java
@@ -52,6 +52,7 @@ import com.google.gson.JsonElement;
 import org.apache.commons.lang3.Validate;
 import org.hl7.fhir.instance.model.api.IBase;
 import org.hl7.fhir.instance.model.api.IBaseResource;
+import org.hl7.fhir.instance.model.api.IIdType;
 import org.hl7.fhir.instance.model.api.IPrimitiveType;
 import org.hl7.fhir.r4.model.Identifier;
 import org.hl7.fhir.utilities.npm.IPackageCacheManager;
@@ -329,11 +330,22 @@ public class PackageInstallerSvcImpl implements IPackageInstallerSvc {
 
 				ourLog.info("Creating new resource matching {}", map.toNormalizedQueryString(myFhirContext));
 				theOutcome.incrementResourcesInstalled(myFhirContext.getResourceType(theResource));
-				createResource(dao, theResource);
 
+				IIdType id = theResource.getIdElement();
+
+				if (id.isEmpty()) {
+					createResource(dao, theResource);
+					ourLog.info("Created resource with new id");
+				} else {
+					if (id.isIdPartValidLong()) {
+						String newIdPart = "npm-" + id.getIdPart();
+						id.setParts(id.getBaseUrl(), id.getResourceType(), newIdPart, id.getVersionIdPart());
+					}
+					updateResource(dao, theResource);
+					ourLog.info("Created resource with existing id");
+				}
 			} else {
-
-				ourLog.info("Updating existing resource matching {}", map.toNormalizedQueryString(myFhirContext));
+			ourLog.info("Updating existing resource matching {}", map.toNormalizedQueryString(myFhirContext));
 				theResource.setId(searchResult.getResources(0, 1).get(0).getIdElement().toUnqualifiedVersionless());
 				DaoMethodOutcome outcome = updateResource(dao, theResource);
 				if (!outcome.isNop()) {
diff --git a/hapi-fhir-jpaserver-base/src/test/java/ca/uhn/fhir/jpa/packages/NpmR4Test.java b/hapi-fhir-jpaserver-base/src/test/java/ca/uhn/fhir/jpa/packages/NpmR4Test.java
index ec088316919..69179d6839c 100644
--- a/hapi-fhir-jpaserver-base/src/test/java/ca/uhn/fhir/jpa/packages/NpmR4Test.java
+++ b/hapi-fhir-jpaserver-base/src/test/java/ca/uhn/fhir/jpa/packages/NpmR4Test.java
@@ -259,9 +259,36 @@ public class NpmR4Test extends BaseJpaR4Test {
 			map.add(StructureDefinition.SP_URL, new UriParam("http://hl7.org/fhir/uv/shorthand/CodeSystem/shorthand-code-system"));
 			IBundleProvider result = myCodeSystemDao.search(map);
 			assertEquals(1, result.sizeOrThrowNpe());
+			IBaseResource resource = result.getResources(0, 1).get(0);
+			assertEquals("CodeSystem/shorthand-code-system/_history/1", resource.getIdElement().toString());
 		});
 	}
 
+	@Test
+	public void testNumericIdsInstalledWithNpmPrefix() throws Exception {
+			myDaoConfig.setAllowExternalReferences(true);
+
+			// Load a copy of hl7.fhir.uv.shorthand-0.12.0, but with id set to 1 instead of "shorthand-code-system"
+			byte[] bytes = loadClasspathBytes("/packages/hl7.fhir.uv.shorthand-0.13.0.tgz");
+			myFakeNpmServlet.myResponses.put("/hl7.fhir.uv.shorthand/0.13.0", bytes);
+
+			PackageInstallationSpec spec = new PackageInstallationSpec().setName("hl7.fhir.uv.shorthand").setVersion("0.13.0").setInstallMode(PackageInstallationSpec.InstallModeEnum.STORE_AND_INSTALL);
+			PackageInstallOutcomeJson outcome = myPackageInstallerSvc.install(spec);
+			// Be sure no further communication with the server
+			JettyUtil.closeServer(myServer);
+
+			// Search for the installed resource
+			runInTransaction(() -> {
+				SearchParameterMap map = SearchParameterMap.newSynchronous();
+				map.add(StructureDefinition.SP_URL, new UriParam("http://hl7.org/fhir/uv/shorthand/CodeSystem/shorthand-code-system"));
+				IBundleProvider result = myCodeSystemDao.search(map);
+				assertEquals(1, result.sizeOrThrowNpe());
+				IBaseResource resource = result.getResources(0, 1).get(0);
+				assertEquals("CodeSystem/npm-1/_history/1", resource.getIdElement().toString());
+			});
+
+	}
+
 	@Test
 	public void testInstallR4Package_NonConformanceResources() throws Exception {
 		myDaoConfig.setAllowExternalReferences(true);
diff --git a/hapi-fhir-jpaserver-base/src/test/resources/packages/hl7.fhir.uv.shorthand-0.13.0.tgz b/hapi-fhir-jpaserver-base/src/test/resources/packages/hl7.fhir.uv.shorthand-0.13.0.tgz
new file mode 100644
index 00000000000..139cae87f93
Binary files /dev/null and b/hapi-fhir-jpaserver-base/src/test/resources/packages/hl7.fhir.uv.shorthand-0.13.0.tgz differ