How to Look Up an NPI Number

Looking up a National Provider Identifier (NPI) can help you identify an individual health care provider or organization and review publicly available information associated with the provider's NPI record.

You don't necessarily need to know the NPI number to perform a search. Depending on the information available, you may be able to search using the provider's name, organization name, city, state or other criteria.

Use the Eclaims NPI Lookup to search available NPI information and narrow the results using the information you already know about the provider.

What Is an NPI Lookup?

An NPI lookup searches publicly available provider information associated with National Provider Identifiers assigned through the National Plan and Provider Enumeration System (NPPES).

NPPES contains information about individual and organization health care providers that have been assigned NPIs. Certain NPPES provider information is made publicly available and can be searched to help identify a provider and review information associated with an NPI.

If you're unfamiliar with NPIs, see What Is an NPI Number? Complete Guide to National Provider Identifiers for an introduction to how NPIs are assigned and used in health care transactions.

How to Search for an NPI Number

The best way to search depends on what information you already have. An exact NPI number provides the most specific search, but provider names and location information can also be useful when the NPI is unknown.

How to Narrow Down NPI Search Results

A broad search can return multiple possible matches. When that happens, use additional information to determine which record is most likely associated with the provider you're trying to identify.

For example, if searching for a provider named John Smith returns many results, adding the provider's state or city may significantly reduce the number of possible matches.

When reviewing the remaining results, compare information such as:

• Provider or organization name
• Entity type
• Practice location
• Taxonomy or provider classification
• NPI status and other available record information

Don't rely on a matching name alone when several records are returned. Use as much known information as possible to identify the appropriate provider record.

What Information Can an NPI Lookup Show?

The information available in an NPI record can help provide context about the provider associated with the number. Depending on the provider and available public data, an NPI search may include information such as:

• NPI number
• Individual provider or organization name
• Entity type
• Practice location information
• Mailing information
• Taxonomy codes
• Enumeration date
• Last update date
• NPI status or deactivation information, when applicable

Public NPPES data can contain additional information depending on whether the NPI belongs to an individual or organization and the information associated with that provider's record.

What Does the NPI Enumeration Date Mean?

The enumeration date identifies when the provider was assigned the NPI.

It should not be interpreted as the date the provider became licensed, began practicing or enrolled with a particular health plan. Those are separate events and are not established simply by the NPI enumeration date.

What Does the NPI Last Update Date Mean?

The last update date reflects an update associated with the provider's NPPES record. Providers are responsible for keeping information associated with their NPI current.

A recent update date does not necessarily mean that every piece of information in the record changed. Likewise, information displayed in an NPI lookup should be reviewed in the context of the provider information being researched.

How Can I Tell Whether an NPI Belongs to an Individual or Organization?

NPI records identify whether the provider is an individual or an organization.

• Type 1 NPI – identifies an individual health care provider.
• Type 2 NPI – identifies a health care organization.

This distinction can be important when several related NPI records appear in a search. For example, an individual physician may have a Type 1 NPI while the physician's group practice or incorporated organization has a separate Type 2 NPI.

See NPI Type 1 vs. Type 2: What's the Difference? for a detailed explanation of individuals, organizations, sole proprietors and organization subparts.

Why Might I Find More Than One NPI When Searching for a Provider?

Finding multiple results does not necessarily mean that something is wrong with the search.

Multiple results can occur for several reasons, including:

• Different providers have the same or similar names.
• An individual provider is associated with an organization that has its own NPI.
• An organization has related organizational entities or subparts with separate NPIs.
• Search criteria are broad enough to match providers in multiple locations.

Review the entity type, location, taxonomy and other available information before deciding which NPI is appropriate for your purpose.

Can I Look Up an NPI from a Health Care Claim?

Yes. If an NPI appears on a health care claim or related transaction, an NPI lookup can help identify the individual provider or organization associated with the number.

This can be particularly useful when reviewing provider information on a professional claim because a claim may contain NPIs associated with different provider roles, such as:

• Billing provider
• Rendering provider
• Referring provider
• Ordering provider
• Supervising provider

Identifying the provider associated with an NPI is only part of the process. You may also need to determine which provider role the NPI represents on the claim. For two of the most common professional claim roles, see Billing Provider NPI vs. Rendering Provider NPI: What's the Difference?

Does an NPI Lookup Verify That a Provider Is Licensed or Credentialed?

No. Finding a provider in an NPI search does not establish that the provider is currently licensed, credentialed, enrolled with a health plan or eligible for payment.

An NPI is a provider identifier. CMS specifically notes that issuance of an NPI does not ensure or validate that a health care provider is licensed or credentialed.

When licensing, credentialing, network participation or payer enrollment must be verified, use the appropriate authoritative source for that information rather than relying solely on the NPI record.

What If the Information in an NPI Record Is Incorrect?

NPI lookup information is based on information maintained through NPPES. If information associated with a provider's NPI is incorrect or outdated, the provider or an authorized person acting on the provider's behalf should update the NPPES record.

Information such as provider names, practice locations and other record details can change over time, which makes maintaining accurate NPPES information important.

Search for an NPI

Start with the information you know and add additional search criteria when necessary to narrow the results. Once you've located a possible match, review the available provider information rather than relying on the provider name alone.

Supporting NPI Resources

• What Is an NPI Number? Complete Guide to National Provider Identifiers
• NPI Type 1 vs. Type 2: What's the Difference?
• NPI Lookup
• NPI Validation Tool