WHAT IS A NATIONAL PROVIDER IDENTIFIER

How to Look Up an NPI 

There are many ways to perform an NPI lookup for a provider or an organization. The official NPI lookup website is the NPPES NPI Registry. This is a free service to anyone. You can start with the NPI number or with a name. The search result includes the NPI number, the first and last name of the provider, the NPI type indicated with icons, primary practice address, phone, and primary taxonomy. The results are shown in the search result window and can be downloaded, or, even more streamlined and efficient, through an application programming interface (API).

Understanding NPI Lookup Results: 

  • NPI: As explained above, the NPI is a unique, 10-digit National Provider Identifier (NPI) assigned to the provider.
  • Enumeration Date: The enumeration date refers to the date the NPI was assigned.
  • NPI Type: There are two types of NPI numbers. Type 1 NPIs are assigned to individual providers. Type 2 NPIs are assigned to Organizational Providers.
  • Status: Identifies if the NPI is Active or Deactivated.
  • Address: Refers to the address associated with the NPI. It may include a mailing address, a primary address, and/or a secondary address.
  • Taxonomy: Taxonomy Codes categorize the type, classification, and/or specialization of health care providers. Providers can select more than one taxonomy code, but one of them must be designated as the primary taxonomy. In addition to the primary and selected taxonomies, the NPPES search will also return the state code and license number associated with the taxonomy.
  • Other Identifiers: This field matches NPIs with insurers such as Medicare and Medicaid or other insurers to help insurers recognize the provider. This field also returns number and state codes.
  • Endpoint Information: This field shows where the client can access service, usually a direct address and/or a URL. It can also include endpoint description, use, content type, and affiliation.

Tracking actions to a standardized identifier provides transparency that can impede and identify fraud. Verisys uses the NPI as one of many data points when verifying provider identity for its clients who use Verisys’ data engines for the provider credentialing process. The NPI number is a unique identifier, but doesn’t imply that the provider is properly licensed, hasn’t been excluded or sanctioned. A full data profile that is current, historical, and accesses thousands of primary sources of relevant data such as professional licensing boards, controlled substance license verification, the OIG LEIE, OFAC, Social Security Death Master File, abuse and sex offender registries, FACIS® among other critical data sources, show the true nature of a provider. This is the key to ensuring quality care, quality outcomes, patient safety, and fraud prevention.

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