Verify Your Information in the National Plan and Provider Enumeration System (NPPES)

Verify Your Information in the National Plan and Provider Enumeration System (NPPES)

October 2016
CRE TA Center
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HHS's Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign national provider identifiers (NPls), unique 10-digit codes to identify both healthcare organizations and individual providers. 

Whether you are establishing or expanding contracts or billing with Medicaid and Marketplace Insurance Plans, verifying your information in NPPES now can prevent problems with contracting and billing later. Inconsistent information can lead to delayed applications for insurance contracts. 

Follow these easy steps:

  • Verify Your Organization's National Provider Identifier (NPI) - Make sure that the organization name is the same as the legal business name. A common mistake is that the name listed in the NPI is not the organization's legal business name.
  • Verify Your Organization's Physical Address and Taxonomy Code - Ensure that your organization’s physical address and taxonomy codes are correct. For example, a health department’s primary taxonomy code should be listed as public health or welfare not behavioral health. 

Remember, staff providing direct services to clients for which you plan to bill insurers need an individual NPI in addition to your organization NPI. Be sure to verify their information as well!