Healthcare Providers

Our Healthcare Provider records are sourced from the CMS National Provider Identifier (NPI) Registry (NPPES), state medical boards, and healthcare licensing databases. These records help verify healthcare professional credentials and practice information.

• Coverage Nationwide (federal and state data)
• Records 8+ Million healthcare providers
• Sources CMS NPI Registry (NPPES), State Medical Boards, Healthcare Provider Databases
• Legal Basis HIPAA Administrative Simplification, State medical practice acts

What Is the NPI Registry?

The National Provider Identifier (NPI) is a unique 10-digit identification number assigned to healthcare providers in the United States. Established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the NPI system was created to simplify the administrative processes involved in healthcare billing, claims processing, and provider identification. Before the NPI system was implemented in 2007, healthcare providers used a patchwork of different identification numbers depending on the insurance plan or government program they worked with. A single physician might have had separate identifiers for Medicare, Medicaid, Blue Cross, and each private insurer, creating enormous administrative overhead.

The Centers for Medicare and Medicaid Services (CMS) manages the NPI system through its National Plan and Provider Enumeration System (NPPES). Every healthcare provider who transmits health information electronically in connection with HIPAA-covered transactions is required by federal law to obtain an NPI. This includes physicians, dentists, nurses, chiropractors, pharmacies, hospitals, nursing facilities, and virtually every other entity that provides healthcare services. Importantly, the NPI is permanent: once assigned, it remains with the provider regardless of job changes, relocations, or retirement. The NPI itself contains no embedded information about the provider -- it is simply a unique number used for identification purposes.

The NPPES database is publicly accessible and updated on a weekly basis. Anyone can download the full data set or search for individual providers through the NPI Registry website. This transparency is intentional: it enables patients, insurers, hospitals, and regulatory agencies to verify provider identities, confirm enrollment in federal healthcare programs, and streamline the claims adjudication process. The registry currently contains records for more than 8 million healthcare providers and organizations across the country.

Types of Healthcare Provider Data

Healthcare provider data encompasses a wide spectrum of professionals who are licensed, certified, or otherwise authorized to deliver medical care. Understanding the different categories of providers helps clarify the scope and depth of available records. The NPI system recognizes two broad entity types: Type 1 (individual providers) and Type 2 (organizational providers).

Physicians and Surgeons: This is the largest category of individual providers and includes doctors of medicine (MD) and doctors of osteopathic medicine (DO) across all specialties. Records cover primary care physicians, cardiologists, orthopedic surgeons, psychiatrists, anesthesiologists, radiologists, oncologists, and every other recognized medical specialty. Each physician's NPI record includes their primary and secondary taxonomies, which indicate their areas of practice.

Nurses and Advanced Practice Providers: The registry includes registered nurses (RN), licensed practical nurses (LPN), nurse practitioners (NP), certified registered nurse anesthetists (CRNA), and clinical nurse specialists (CNS). As nurse practitioners have gained prescribing authority and independent practice rights in many states, their NPI records have become increasingly important for credential verification.

Dentists and Oral Health Professionals: General dentists, orthodontists, oral surgeons, periodontists, endodontists, and dental hygienists are all represented in the NPI system. Dental records are particularly useful because many dental professionals operate independent practices, and their NPI data can help verify practice locations and specialties.

Pharmacists and Pharmacy Technicians: Individual pharmacists carry their own NPIs, while pharmacies (retail, mail-order, compounding, and hospital) are registered as Type 2 organizational providers. This dual registration system helps trace both the individual professional and the dispensing facility.

Allied Health Professionals: Physical therapists, occupational therapists, speech-language pathologists, respiratory therapists, clinical psychologists, licensed clinical social workers, registered dietitians, and audiologists are all included. These professionals form the backbone of rehabilitative, behavioral health, and supportive care services across the nation.

Organizational Providers: Hospitals, clinics, nursing homes, home health agencies, ambulance services, laboratories, imaging centers, durable medical equipment suppliers, and group practices are all registered as Type 2 entities. These organizations may have hundreds of individual providers practicing under their umbrella, each with their own separate NPI.

What Information Is Available?

Each record in the NPI Registry contains a standardized set of data fields that paint a detailed picture of the provider's professional identity. The core fields include the 10-digit NPI number itself, the provider's full legal name (for individuals) or organization name (for entities), and their mailing and practice location addresses. For individual providers, the record also includes any name suffixes or credentials (such as MD, DO, DDS, or PhD).

Taxonomy Codes: Perhaps the most informative element of an NPI record is the Healthcare Provider Taxonomy Code. This is a standardized classification system maintained by the National Uniform Claim Committee (NUCC) that categorizes providers by their type, specialty, and area of practice. A provider can list a primary taxonomy and up to 14 additional taxonomies. For example, a family medicine physician might have taxonomy code 207Q00000X (Family Medicine) as their primary classification, with 207QA0505X (Adult Medicine) as a secondary taxonomy. These codes allow researchers, insurers, and patients to quickly identify what kind of care a provider is qualified to deliver.

Practice Address and Contact Information: The registry records both the provider's mailing address and their primary practice location address. This distinction matters because many providers receive correspondence at a billing office or corporate headquarters that is different from where they actually see patients. The practice location address is generally the more useful piece of information for patients trying to locate a provider.

Enumeration Date and Status: Each record shows when the NPI was originally assigned and whether the provider's NPI is currently active or has been deactivated. Deactivation can occur when a provider retires, passes away, or is no longer practicing. The NPI itself is never reassigned to another provider even after deactivation.

Other Provider Identifiers: The NPPES data also includes other identifiers that a provider may hold, such as a Medicare UPIN (Unique Physician Identification Number), state license numbers, and DEA (Drug Enforcement Administration) numbers. These cross-references allow users to connect NPI data with state licensing boards and federal prescribing authority records.

How Healthcare Provider Data Is Collected

The process of collecting and maintaining healthcare provider data involves multiple federal and state agencies working in parallel. At the federal level, CMS requires all providers who bill Medicare or Medicaid to enroll through the Provider Enrollment, Chain, and Ownership System (PECOS). During enrollment, providers submit detailed information about their education, training, licensure, practice locations, and organizational affiliations. This data feeds directly into the NPPES database and is cross-referenced against other federal databases for validation.

State medical boards serve as the primary licensing authorities for physicians and surgeons. Each state has its own medical board (or equivalent regulatory body) that processes applications, conducts background checks, verifies medical education credentials, confirms completion of residency training, and administers or recognizes board certification examinations. When a physician applies for a state medical license, the board verifies their graduation from an accredited medical school, successful completion of the United States Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), and completion of an accredited residency program. This verification process often involves contacting medical schools, residency programs, and the Educational Commission for Foreign Medical Graduates (ECFMG) for international medical graduates.

The Drug Enforcement Administration (DEA) maintains a separate registration system for providers authorized to prescribe controlled substances. A DEA registration number is linked to a specific provider at a specific address and must be renewed periodically. DEA registration data is not fully public, but the registration status can often be cross-referenced through state prescription drug monitoring programs (PDMPs).

Specialty board certification organizations such as the American Board of Medical Specialties (ABMS) and its 24 member boards also contribute to the healthcare data ecosystem. Board certification is voluntary but widely regarded as a marker of advanced competency in a specialty area. Certification status, including any maintenance of certification (MOC) activities, is tracked by these organizations and is sometimes included in aggregated provider databases.

Using Healthcare Provider Data

Healthcare provider data serves a wide range of practical purposes for patients, employers, insurers, healthcare organizations, and researchers. One of the most common uses is credential verification. Hospitals, clinics, and health plans are required to verify the credentials of every provider they employ or contract with through a process known as credentialing. This involves confirming the provider's identity, education, training, licensure, board certification, malpractice history, and work history. The NPI Registry and state medical board databases are foundational resources in this process.

Finding specialists is another frequent use case. Patients who need to see a specialist -- whether it is a dermatologist, endocrinologist, or orthopedic surgeon -- can search the NPI Registry by taxonomy code and geographic location to identify providers in their area. While the NPI Registry does not include patient reviews or quality ratings, it provides verified practice addresses and specialty classifications that can help narrow down options.

Insurance network verification relies heavily on NPI data. When a patient wants to confirm whether a provider is in-network with their insurance plan, the NPI number serves as the universal identifier that links the provider across different insurance systems. Health plans use NPI numbers to build and maintain their provider directories, process claims, and coordinate benefits.

Research and analytics represent a growing area of use. Health services researchers use NPPES data to study the geographic distribution of providers, identify healthcare deserts (areas with insufficient provider coverage), analyze referral patterns, and evaluate workforce trends. Public health agencies rely on this data to plan resource allocation and assess whether communities have adequate access to primary care, mental health services, and specialty care.

Data Accuracy and Limitations

While the NPI Registry is one of the most comprehensive healthcare provider databases in the world, it has important limitations that users should understand. First and foremost, the NPI does not verify or attest to the quality of care a provider delivers. Having an active NPI means that a provider has registered with CMS and has been assigned an identification number -- it does not mean they are board certified, in good standing with their state medical board, or currently accepting patients.

Address accuracy is another known challenge. Providers are responsible for updating their own NPPES records when they change practice locations, but many fail to do so in a timely manner. Studies have found that a significant percentage of practice addresses in the NPPES database are outdated, incorrect, or correspond to billing addresses rather than patient-facing clinical locations. CMS has taken steps to improve data quality, including requiring periodic re-validation of enrollment data, but gaps persist.

The NPI Registry does not include information about malpractice claims, disciplinary actions, or criminal history. For that information, users need to consult the National Practitioner Data Bank (NPDB), which is a federal repository of reports on medical malpractice payments, adverse licensure actions, adverse clinical privileges actions, and adverse professional society actions. However, the NPDB is not publicly accessible -- only authorized entities such as hospitals, health plans, and state licensing boards can query it.

Deactivated NPI records remain in the database but are flagged as inactive. A provider whose NPI has been deactivated may have retired, changed careers, lost their license, or even passed away. The presence of a record in the NPPES database should not be taken as confirmation that a provider is currently practicing.

Frequently Asked Questions