How to Look Up a Doctor's NPI Record and Check a State Medical License

What an NPI is

The National Provider Identifier is a standard created under the Administrative Simplification rules of the Health Insurance Portability and Accountability Act (HIPAA). According to the CMS NPI Standard page, it is a unique 10-position, "intelligence-free" numeric identifier. That means the digits carry no information about the provider, such as the state where they practice or their specialty. The regulation that defines the number, 45 CFR 162.406, adds that the tenth digit is a check digit.

CMS issues NPIs through the National Plan and Provider Enumeration System (NPPES). Under 45 CFR 162.410, a health care provider that is a HIPAA covered entity must obtain an NPI and use it in standard electronic transactions such as claims. Health plans and clearinghouses must use the NPI to identify providers in those transactions too.

When HHS adopted the NPI in its 2004 final rule, it described the number as a permanent identifier, assigned for life unless circumstances justify deactivation. Because the number says nothing about location or specialty, a provider who moves, changes employers or changes specialty keeps the same NPI and updates the NPPES record instead. Covered providers must report changes to their required NPPES data within 30 days under 45 CFR 162.410(a)(4).

Type 1 and Type 2 NPIs

• Type 1 (individual): a person who provides health care, for example a physician, nurse practitioner, physician assistant, dentist, chiropractor or physical therapist. A sole proprietor also uses a Type 1 NPI.
• Type 2 (organization): an organization such as a hospital, group practice, clinic, laboratory, pharmacy or nursing facility. A large organization can have separate NPIs for its subparts, for example a hospital's outpatient departments.

The regulation also lets an organization obtain NPIs for its subparts (45 CFR 162.408). On T-MedInfo, a Type 1 NPI has a clinician profile and a Type 2 NPI has a facility profile. A clinician's own NPI stays with them personally, while the groups and hospitals where they work usually have their own Type 2 numbers.

How to look up an NPI record

Step 1: search the NPPES NPI Registry

The NPPES NPI Registry is the public search tool from CMS. CMS describes it on its data dissemination page as a query-only database that is updated daily. You can search by NPI number, by a person's name, by organization name, or by location. The search is free and needs no account.

Step 2: compare the main fields

Open the record and compare it with what you already know about the provider:

• Name and credential: the credential (for example MD, DO, NP or PA) is text the provider typed into NPPES. It is not checked by CMS against a diploma or license.
• Practice location and phone: the primary practice address and any secondary locations the provider reported.
• Taxonomy: one or more specialty codes from the NUCC code set, with one marked as primary. Our taxonomy guide explains how to read them.
• License number and state: listed next to a taxonomy code, as reported by the provider.
• Enumeration date and last update: when the NPI was issued and when the record was last changed.
• Status: an active NPI, or a deactivated one. Our guide to deactivated NPIs explains what deactivation means.

Step 3: check the license with the state board

An NPI shows that a provider registered with NPPES. It does not show that they may legally practice today: the CMS page for NPPES downloads states plainly that issuance of an NPI does not ensure or validate that the provider is licensed or credentialed. Each state licenses its own clinicians, and the state board is the authority on license status, expiration and public disciplinary orders. The Federation of State Medical Boards keeps a directory of state medical boards with links to their websites, where the license lookup tools are. Our license verification guide walks through that check.

Step 4: check federal program exclusions if it matters to you

The HHS Office of Inspector General publishes the List of Excluded Individuals/Entities. It names people and organizations excluded from Medicare, Medicaid and other federal health programs. The NPI Registry does not show exclusions, so this is a separate search.

What an NPI record does not tell you

Because NPPES is an administrative registry, several things patients often look for are not in it:

• Current license status. NPPES stores the license number the provider reported, not the board's current status.
• Board certification. Board certification is not part of NPPES, and CMS's data dictionary for its Doctors and Clinicians file says that file has no board certification information either. For physicians it is issued by specialty boards; the American Board of Medical Specialties offers Certification Matters to check ABMS member-board certification.
• Medicare assignment. Whether a clinician accepts the Medicare-approved amount as full payment comes from a different CMS dataset, the Doctors and Clinicians file. See our Medicare assignment guide.
• Quality, outcomes, reviews or malpractice history. NPPES collects none of these.
• Insurance networks. Ask your health plan or check its provider directory.

Records can also be out of date. Providers must report changes, but the registry only reflects what was submitted. If the address or phone in the registry is different from what the office tells you, the office is usually the better guide for booking, while the record may simply not have been updated yet.

How T-MedInfo uses NPI data

Every profile on this site starts from the NPPES record: name, credential text, addresses, phone, taxonomy codes, license numbers as reported, and status. We load the public NPPES monthly file and keep earlier snapshots, so a profile can show a history timeline of address, name, specialty and status changes.

Where CMS publishes more data for the same NPI, the profile adds it and names the dataset: the Medicare Doctors and Clinicians file (medical school, graduation year, assignment and telehealth indicators), Medicare enrollment and ordering and referring eligibility, Medicare Part B services, Medicare Part D prescriptions and Open Payments. Sections are shown only when the dataset has a record for that NPI.

We show license numbers exactly as reported to NPPES. We do not check them against state records; instead, each clinician profile links to the lookup page of the state board for the practice state.

If you are the provider and something is wrong, update it in NPPES so every directory receives the change, or send us a data update request.

Signs that deserve a second look

None of these means something is wrong, but each is a reason to ask the office or check the state board:

• The name or credential in the record does not match what the office or website shows.
• The NPI is deactivated, but the provider is still billing or scheduling visits under it.
• The license state in the record is not the state where you will be treated, including for a video visit.
• The taxonomy code does not match the kind of care the provider offers you.