Documentation · Updated October 27, 2026
How our NPI lookup works
Where every number comes from, how often it updates, how we match names and NPIs, what each result means, and what the tool can’t do. Written so a compliance officer or auditor can rely on it, and check us.
What happens when you search
- The NPI is checked for a valid check digit as you type. The 10th digit of every NPI is calculated from the first nine; a number that fails can’t be real.
- The CMS NPI Registry is searched live by number, name, organization, city, ZIP code or specialty. Up to 20 records come back, with every address, taxonomy, license number, other name and identifier the provider reported.
- Each record is matched to CMS Medicare data by NPI: enrollment and revalidation due date, eligibility to order and refer, and any opt-out.
- Each record is screened against the OIG list, SAM.gov and 32 state Medicaid lists, by NPI and by name.
- You can save the result as a dated PDF record, print it, or email it to yourself, with the source and date of every list used.
Data sources and update schedule
| Source | What it gives | How current | Publisher |
|---|---|---|---|
| CMS NPI Registry (NPPES) | Provider name, type, status, taxonomies and license numbers as reported, addresses, other names and identifiers | Live, at the moment you search | CMS |
| OIG List of Excluded Individuals and Entities | Federal health care program exclusions | OIG publishes monthly; we download it every Monday and Thursday | HHS OIG |
| SAM.gov exclusions extract | Federal exclusions and debarments, including OIG’s | GSA publishes daily; we download every Monday and Thursday | GSA |
| State Medicaid exclusion lists (32) | Providers a state terminated, suspended or excluded from its Medicaid program | Each state’s own schedule; we download every Monday and Thursday | Each state agency |
| CMS Order and Referring | Whether an individual may order or refer Part B, DME, HHA, PMD and hospice services | CMS updates about twice a week; we download every Monday and Thursday | CMS |
| CMS Opt Out Affidavits | Providers who opted out of Medicare, with dates | CMS monthly; we download every Monday and Thursday | CMS |
| CMS Revalidation Due Date List | Medicare enrollments with state, provider type, specialty and revalidation due date | CMS monthly; we download every Monday and Thursday | CMS |
The state lists currently searched: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, Texas, Washington, West Virginia and Wyoming. The state directory covers every other state, with how to search it by hand.
Updates are automatic. Every Monday and Thursday a scheduled job rebuilds the site, which downloads each list again from its official source. Each copy must pass a minimum-size check (a list that suddenly shrinks is treated as a failed download), and if a download fails the last good copy stays in place and is labelled as such.
How matching works
- NPI matches are exact: the 10 digits must be the same. They are shown as “NPI on a list”.
- Person matches need the last name (including multi-part names written with or without spaces, such as “De La Cruz” and “DeLaCruz”) and a compatible first name: the same name, an initial, or one name that starts the other (“Rob” and “Robert”). Middle names and suffixes are ignored.
- Business matches look for the business name inside the listed name, ignoring punctuation and case.
- PDF-based state lists are searched line by line; when an entry wraps onto two lines, the neighbouring line is used for the first name. A hit shows the entry exactly as the state printed it.
- We cap results at 25 per list per search. A very common name with many hits should be narrowed by state or NPI.
What each result means
| Result | Meaning |
|---|---|
| Active (NPPES) | The registry returned an active record for this NPI. |
| Not found in NPPES | No active record. The NPI may be deactivated (death, disbandment, fraud or other) or never issued, or the number is mistyped. |
| Invalid check digit | The 10th digit doesn’t match the first nine under the NPI check-digit formula, so the number cannot be a real NPI. |
| Enrolled (Medicare) | The NPI is on CMS’s Revalidation Due Date List, which lists Medicare enrollments. |
| Eligible to order and refer | The individual is on CMS’s Order and Referring file for the categories shown. |
| Opted out | CMS lists a Medicare opt-out covering today’s date. |
| NPI on a list | An exclusion list carries this exact NPI. Strong evidence; still confirm on the official source. |
| Possible match | A name on an exclusion list matches. Many people share names: confirm with the record’s details before acting. |
| No match | Nothing matched on the lists that were searched, as of the dates shown. It says nothing about lists that were not searched. |
What the tool cannot do
- It doesn’t verify licenses. The license numbers shown come from NPPES, where providers enter them and CMS does not verify them. Each one links to the state board’s official search on our license lookup.
- It isn’t PECOS. Medicare columns come from three CMS public datasets. They are official, but for a billing or enrollment decision confirm in PECOS or with your Medicare Administrative Contractor.
- It doesn’t search every state. States that publish no list, only a search form, or block downloads are named in every result, with manual steps.
- It can’t see deactivated NPIs’ details. The registry returns active NPIs only; a deactivated NPI shows as “not found”.
- It doesn’t prove identity. Compare the record with the person’s ID, license and application.
- It isn’t legal advice. If you confirm an exclusion, talk to a health care lawyer.
Privacy
Exclusion and Medicare checks run in your browser against static files on our site, so the names you screen are not sent to us. NPI Registry searches pass through our server to CMS, because CMS doesn’t accept direct calls from browsers; we don’t store them. Practice Pro stores the list a subscriber saves, only to re-check it. See the privacy policy.
Change log
- October 27, 2026: Louisiana added (32 state lists). Medicare enrollment, ordering/referring and opt-out added to every NPI result; full NPI record (all addresses, other names, identifiers); bulk NPI lookup for up to 100 NPIs; clear notice and fallback when the NPI Registry is unavailable.
- October 26, 2026: Arkansas added (31 state lists); email-me and monthly re-check reminders.
- October 2026: State coverage extended from 16 to 30 lists; every result lists states not searched, with manual steps.
Questions
Is the data official?
Every result comes from a government source: CMS, HHS OIG, GSA and state Medicaid agencies. We don’t add, edit or estimate records. We reformat them so they can be searched quickly, and every result names its source and the date of the copy used.
How do I know the data is current?
The tool shows the date of each list next to the search button and in every PDF record. The NPI Registry is queried live; everything else is downloaded again every Monday and Thursday, automatically.
What happens if a government download fails?
The site keeps the last good copy and says so, rather than showing partial data. If no good copy exists, that list is marked unavailable and the result says it was not searched.
Do you store my searches?
No. Exclusion and Medicare checks run in your browser against files on our site; the names you type aren’t sent to us. For the NPI Registry search, the search terms pass through our server to CMS (CMS doesn’t allow browsers to call it directly) and are not stored. If you choose to email yourself a record, we keep your email address and the counts, not the names.
Why are some states not searched?
Some states publish no list, some only offer a one-at-a-time search form, and some block automated downloads. The result lists every state that was not searched, with the manual steps for each.
Sources
- CMS, NPPES NPI Registry API — live NPI records
- CMS, NPI Fact Sheet (December 2024) — an NPI does not ensure licensure; NPPES data is self-reported
- CMS, NPPES Data Dissemination code values (deactivation reasons: death, disbandment, fraud, other) — NPI deactivation reason codes
- HHS OIG, LEIE downloadable database — OIG LEIE download
- GSA, SAM.gov Entity/Exclusions Extracts Download API (daily public exclusions extract) — SAM.gov daily exclusions extract
- CMS, Order and Referring dataset — ordering and referring eligibility
- CMS, Order and Referring methodology (data.cms.gov) — how CMS builds the ordering and referring file and how often it updates
- CMS, Opt Out Affidavits dataset — Medicare opt-outs
- CMS, Revalidation Due Date List dataset (due dates set for the next six months; others TBD) — Medicare enrollments and revalidation due dates
Documentation checked October 27, 2026. General information, not legal advice.