If you work in the health care industry, you’ve come across NPPES Registry. NPPES (National Plan and Provider Enumeration System) is the platform where you apply to acquire NPI (National Provider Identifier), whether as an individual or organization. NPPES maintains a full list of health care providers with NPI. NPPES Registry, the free online catalog provided by CMS (Centers for Medicare and Medicaid Services), allows users to find all dynamic NPI data.

The NPPES information can be accessed through a downloadable file or query-able database known as the NPI registry. The registry and the downloadable file contain data from NPPES as provided by the health care provider or authorized official or organization acting on behalf of the provider. If the displayed information isn’t correct, health care providers can correct it at any time.

The health care provider or an authorized third-party may edit the records by visiting the NPPES website or obtaining the NPI application/update form from the CMS forms page. You can also contact the NPI enumerator via phone, email, or postal address, especially if you are having difficulties correcting the information. Keep in mind that the information displayed on the NPI registry and downloadable file follows FOIA disclosable and eFOIA amendments. This means that you can’t suppress or opt-out the NPPES record data if you have an active NPI, stressing the need to ensure that it is accurate.    

The NPI registry is updated daily to ensure that you find an extensive pool of NPI registered providers, and you can search it using elements such as the provider’s name. On the other hand, NPI downloadable file is updated weekly and monthly, and each update ensures that the data therein is the most current information from NPPES. The update does not maintain historical downloadable files, and the health care providers’ data that is disclosed is subject to adherence with the Freedom of Information Act (FOIA).

Deactivated NPI

If you deactivate your NPI, the FOIA-disclosable data will be disclosed within the files. CMS only discloses the deactivate NPI and associated date of deactivation. If you download the file to share with others, such as on your website, you are advised only to display the same data (deactivated NPI and deactivation date). Note that the deactivated records in NPPES can’t be edited or viewed by the health care providers they were assigned to. Once deactivated, the covered entities should not use the NPI in standard transactions. Health care providers are also not allowed to use or let others use their deactivated NPIs.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 directed the adoption of NIP, standard unique identifiers for health care providers, and health plans. The provisions were designed to facilitate efficiency and effectiveness in electronic health information transmission. CMS developed NPPES to assign unique identifiers. The NPI is a 10-numeric digits identifier that enables a researcher to identify providers. While users can identify a health care provider using the NPI, it doesn’t contain personal details such as state of residence and practice. Applying and getting NPI is free, and it is a must for individuals and organizations covered by HIPAA.