Educational guides, based on CMS and NPPES sources, on checking physician credentials, understanding National Provider Identifiers (NPI), navigating Medicare assignment, and selecting qualified healthcare specialists.
Our guides are created for educational transparency using official data from the U.S. Centers for Medicare & Medicaid Services (CMS) and federal healthcare registries. T-MedInfo does not provide medical diagnosis or treatment advice.
What a National Provider Identifier (NPI) is, how to read a Type 1 or Type 2 record in the NPPES NPI Registry, what the record does not tell you, and how to check a license with the state board.
What it means when a doctor accepts Medicare assignment, how participating, non-participating and opted-out providers differ, what the limiting charge is, and how to check a provider before your visit.
How the NUCC Health Care Provider Taxonomy code set describes provider types and specialties, how primary and secondary codes work in NPPES, and why a taxonomy code is not the same as board certification.
How telehealth visits work, what Medicare covers through December 31, 2027 and what changes after that, licensing across state lines, privacy, prescriptions, and what the telehealth indicator on a provider profile means.
Why an NPI gets deactivated, what the public NPPES data shows about it, why a deactivated record can still be published, and how T-MedInfo displays deactivated and reactivated NPIs.
A practical checklist for finding a specialist: referrals and networks, what public records can and cannot confirm (license, board certification, Medicare assignment), costs, and questions to ask at the first visit.
What the submitted charge, Medicare allowed amount and Medicare payment in CMS Part B data mean, why they differ, how your 20% coinsurance is figured, and the limits of using this data to estimate your own bill.
How the federal Open Payments program works: who reports payments to clinicians and teaching hospitals, the three payment categories, how clinicians can dispute records, and how to read the data without jumping to conclusions.
What the letters after a clinician's name mean: education and licensing for physicians (MD and DO), nurse practitioners, physician assistants and other professions, and how credentials appear in NPI records.
Step-by-step instructions for checking a physician, nurse practitioner or physician assistant license with the right state board, reading status and discipline records, and knowing what license lookups do not show.
How Original Medicare and Medicare Advantage HMO and PPO plans differ in which doctors you can see, when you need a referral, how to check a plan's network before you enroll, and when you can switch.
How Medicare drug coverage works: formularies and tiers, plan rules like prior authorization, the deductible, initial coverage and catastrophic stages, the yearly out-of-pocket cap for 2026 and 2027, Extra Help, and how to compare plans.
What Medicare Part B covers when you see a doctor, the 2026 premium, deductible and 20% coinsurance, preventive services with no cost-sharing, how assignment and the limiting charge affect your bill, and how Part B data on clinician profiles relate to it.
When you need a referral to see a specialist under Original Medicare, Medicare Advantage HMO and PPO plans and job-based or Marketplace coverage, the federal rules on choosing a primary care provider and direct access to OB-GYN care, and how to ask for a referral.
What a primary care provider does, how family medicine, internal medicine, geriatrics, pediatrics, nurse practitioners and physician assistants differ, how to check network and Medicare assignment, and why you have to call to learn whether a practice takes new patients.
What cardiologists do, how general, interventional, electrophysiology and heart failure cardiology differ, when you see a cardiac surgeon instead, how to check a license and board certification, and what CMS data on a profile can and cannot tell you.
What dermatologists treat, how medical, Mohs surgical and cosmetic dermatology differ, who else you may see in a dermatology office, how to check a license and board certification, and what Medicare does and does not pay for.
How orthopedic subspecialties such as joint replacement, spine, sports medicine and hand surgery differ, when a sports medicine physician or physical therapist may be the first stop, what Medicare Part B data show about the procedures a surgeon bills, and questions to ask before surgery.
Who prescribes and who provides therapy: psychiatrists, psychiatric nurse practitioners, psychologists, clinical social workers and counselors, how they appear in NPI records, what Medicare covers including telehealth at home, how to check a license, and where to get help in a crisis.
The types of cancer specialists, how to find an NCI-Designated Cancer Center, second opinions and what Medicare covers for them, how to check a license and board certification, and what Medicare Part B and Part D data on a profile mean.
Where Medicare Part D prescriber data come from, what prescriptions, 30-day fills, days' supply, drug cost and patient counts mean, why CMS hides small counts, what the data cannot show, and why a high count is not a red flag by itself.
A step-by-step guide to finding your doctor in the CMS Open Payments search tool and reading a record: general, research and ownership payments, the nature of payment, direct, indirect and third-party payments, amounts by year and company, disputed records, and how to talk with your doctor about it.
A map of the public records you can check about a doctor: the NPI record, state license and discipline, board certification, Medicare enrollment and billing data, industry payments, federal exclusions, malpractice information and reviews, with what each can and cannot tell you.
The public datasets behind every T-MedInfo profile (NPPES, NUCC, Doctors and Clinicians, Medicare Part B and Part D, Open Payments, PECOS enrollment), how often each is updated, why most cover only Original Medicare, why small counts are hidden, why a profile can differ from Medicare.gov, and how to get a record corrected.
What Medicare enrollment in PECOS means, the difference between enrolled, opted out and not enrolled, why ordering and referring status matters for lab tests, imaging, medical equipment and home health, how revalidation works, and how enrollment appears on T-MedInfo profiles.
How the "Welcome to Medicare" visit, the yearly Wellness visit and a routine physical exam differ, which screenings and vaccines Part B covers with no cost-sharing and how often, when a preventive visit turns into a bill, and how to prepare.
When to call 911, how Medicare defines an emergency and urgently needed care, what emergency departments must do under federal law, when your own clinician or a telehealth visit can help, what Original Medicare and Medicare Advantage cover in each setting, and how to plan ahead.
How the training of nurse practitioners and physicians differs, why what an NP may do on their own depends on state law, how Medicare covers and pays for NP services, NP specialties in NPI records, and questions to ask when your clinician is an NP.
Prepare a written cost-estimate request, check separate billers, save the paperwork and find the CMS route for questions about a missing estimate or a different bill.
Two practical question cards for arranging communication support and checking the entrance, exam room and equipment at the specific office you plan to visit.