Question 1

What is an NPI?

Accepted Answer

The National Provider Identifier (NPI) is a unique 10-digit identification number assigned to healthcare providers in the United States. Established under HIPAA, the NPI is used for identification in standard healthcare transactions. Once assigned, an NPI is permanent and remains with the provider regardless of job or location changes.

Question 2

What is the difference between Individual and Organization NPI?

Accepted Answer

Individual NPIs (first digit 1) are assigned to healthcare practitioners such as physicians, nurses, and therapists. Organization NPIs (first digit 2) are assigned to entities like hospitals, clinics, group practices, and laboratories. You can use our NPI Decoder tool to determine the type from any NPI number.

Question 3

How is an NPI number structured?

Accepted Answer

An NPI is always 10 digits. The first digit indicates type (1 = individual, 2 = organization). Digits 2-9 are a sequential enumeration number. The last digit is a check digit calculated using a modified Luhn algorithm. The standard display format is XXX-XX-XXXX.

Question 4

How do I get an NPI?

Accepted Answer

Apply online at the National Plan and Provider Enumeration System (NPPES) at npiregistry.cms.hhs.gov. Complete the application with your personal or organizational information. Once approved, you receive your permanent 10-digit NPI. Contact the NPI Enumerator at (800) 465-3203 for assistance.

Question 5

How do I update my NPI information?

Accepted Answer

You can update your NPI details (address, name, taxonomy, phone, etc.) in the National Plan and Provider Enumeration System (NPPES). Sign in at npiregistry.cms.hhs.gov with your NPPES credentials and edit your record. Keeping this information current helps other systems and patients find you correctly. For help, contact the NPI Enumerator at (800) 465-3203.

Question 6

When can an NPI be deactivated?

Accepted Answer

An NPI may be deactivated if the provider dies, retires, or no longer needs it (for example, after leaving the country or changing profession). Deactivation can also happen if the NPI was issued in error or if the provider requests it. Once deactivated, the number is no longer used for billing or identification. In some cases, reactivation is possible—contact the NPI Enumerator for your situation.

Question 7

Who is required to get an NPI?

Accepted Answer

Under HIPAA, any healthcare provider who transmits health information electronically in connection with standard transactions (such as claims) must have an NPI. This includes individual practitioners (doctors, nurses, therapists) and organizations (hospitals, clinics, group practices). Health plans and healthcare clearinghouses also need NPIs. If you bill or exchange health data electronically, you generally need an NPI.

Question 8

Where can I look up or verify an NPI?

Accepted Answer

The official source is the NPI Registry at npiregistry.cms.hhs.gov. There you can search by NPI number, name, or organization. On usnpi.com we use the same NPPES data and add search, filters, and maps. For a quick check that a number is valid and whether it is individual or organization, use our NPI Validator and NPI Decoder tools.

Question 9

How do I report an error in NPPES data?

Accepted Answer

If you see wrong information for an NPI (wrong name, address, or taxonomy), the correct way to fix it is through NPPES. The provider or organization that owns the NPI should log in at npiregistry.cms.hhs.gov and update their record. If you are not the owner, you can report a discrepancy to the NPI Enumerator at (800) 465-3203. We display data from NPPES; updates there will eventually appear on usnpi.com after we refresh our data.

Question 10

What are provider licenses?

Accepted Answer

Provider licenses are credentials issued by state medical boards or licensing authorities that authorize healthcare professionals to practice in a specific state. Each license has a unique number and is tied to the state that issued it.

Question 11

Who issues healthcare provider licenses?

Accepted Answer

State medical boards, boards of nursing, and other state regulatory bodies issue licenses. Requirements vary by state and profession. A provider must hold a valid license in each state where they practice.

Question 12

Why does a provider have multiple licenses?

Accepted Answer

Healthcare providers often hold licenses in multiple states because they practice in more than one location, provide telehealth services across state lines, or have relocated. Each state requires its own license for legal practice within its borders.

Question 13

Are NPI license numbers verified?

Accepted Answer

No. License numbers in the NPI registry are self-reported by providers during NPI registration. CMS does not verify or validate that a provider is licensed or credentialed. For official verification, check your state medical board website, the NPPES registry at npiregistry.cms.hhs.gov, or specialty board directories like abms.org.

Question 14

What is a Medicare Provider Number?

Accepted Answer

A Medicare Provider Number (type 04) identifies providers approved to bill Medicare, the federal health insurance program for people 65 and older and certain younger people with disabilities. It is required for processing Medicare claims.

Question 15

What is a Medicaid Provider Number?

Accepted Answer

A Medicaid Provider Number (type 05) is assigned by state Medicaid agencies to providers who participate in Medicaid, the joint federal-state program that helps with medical costs for people with limited income.

Question 16

What is a DEA number?

Accepted Answer

A DEA (Drug Enforcement Administration) number (type 01) is a registration that allows healthcare providers to prescribe, dispense, or handle controlled substances. It is required for prescribing medications like opioids and certain other drugs.

Question 17

What is a CMS Certification Number (CCN)?

Accepted Answer

A CMS Certification Number (type 06) is assigned by the Centers for Medicare & Medicaid Services to facilities like hospitals, nursing homes, and home health agencies that meet federal health and safety standards for Medicare/Medicaid participation.

Question 18

What other identifier types exist?

Accepted Answer

Other common identifiers include: TIN (07) - Tax Identification Number; UPIN (02) - legacy Unique Physician Identification Number, now replaced by NPI; and Other (08) - various state or program-specific identifiers.

Question 19

What is Medicare?

Accepted Answer

Medicare is federal health insurance for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It has four parts: A (hospital), B (medical), C (Medicare Advantage), and D (prescription drugs).

Question 20

What is the difference between Medicare Part A and Part B?

Accepted Answer

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care—usually with no premium if you paid Medicare taxes. Part B covers doctor visits, outpatient care, preventive services, and medical supplies. Part B requires a monthly premium.

Question 21

What is a Medicare Advantage plan?

Accepted Answer

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers. These plans bundle Part A, Part B, and often Part D (prescriptions) into one plan. They may offer extra benefits like vision or dental but typically have provider networks.

Question 22

How do I find providers who accept Medicare assignment?

Accepted Answer

On usnpi.com, search for doctors and filter by "Accepts Medicare Assignment" when available. Our doctor profiles show whether a provider accepts Medicare assignment. You can also use Medicare's official provider directory at medicare.gov.

Question 23

What is Medicaid?

Accepted Answer

Medicaid is a joint federal and state program that helps with medical costs for people with limited income and resources. Eligibility and benefits vary by state. Some people qualify for both Medicare and Medicaid.

Question 24

What does "Accepts Medicare Assignment" mean?

Accepted Answer

"Accepts Medicare Assignment" means the provider agrees to accept the Medicare-approved amount as full payment for covered services. Patients typically pay less out-of-pocket when seeing providers who accept assignment.

Question 25

What is a taxonomy code?

Accepted Answer

A taxonomy code is a standardized identifier that classifies a healthcare provider's specialization in the US healthcare system. It uses a hierarchical structure: Classification, Grouping, and Specialization.

Question 26

What is the difference between a primary and secondary taxonomy?

Accepted Answer

Primary taxonomy indicates the provider's main area of practice—the specialty where they spend most of their time. Secondary taxonomies represent additional specializations where the provider can offer services but does not primarily focus.

Question 27

Can a provider have multiple taxonomy codes?

Accepted Answer

Yes. Providers often have multiple taxonomy codes to reflect their full scope of practice. For example, a physician might have primary taxonomy in Internal Medicine and secondary taxonomies in Geriatrics or Hospice and Palliative Care.

Question 28

How do I find providers by specialty using taxonomy?

Accepted Answer

On usnpi.com, use the Advanced Search or browse providers by state. Filter by taxonomy code or specialty to find providers in a specific area. Each provider profile shows their taxonomy codes and specializations.

Question 29

How are taxonomy codes used?

Accepted Answer

Taxonomy codes help classify providers for claims processing, credentialing, directory listings, and information retrieval. They ensure consistent identification of provider types across healthcare systems.

Question 30

What are HCPCS codes?

Accepted Answer

HCPCS (Healthcare Common Procedure Coding System) is a standardized coding system for medical procedures, supplies, and services. These codes are used for billing, claims processing, and reimbursement through insurance.

Question 31

What is Service Count?

Accepted Answer

Service Count indicates how many times a healthcare provider has performed a specific medical procedure or service. It reflects the volume of that service provided.

Question 32

What is Beneficiary Count?

Accepted Answer

Beneficiary Count is the number of unique patients who received a particular medical service from a provider. It shows how many different people have been treated with that procedure.

Question 33

What is ICD-10-CM?

Accepted Answer

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the standard system for coding diagnoses in the United States. It is used for billing, claims processing, and medical record keeping. HIPAA requires ICD-10-CM for diagnosis coding in healthcare transactions.

Question 34

Where does usnpi.com get ICD-10 data?

Accepted Answer

Our ICD-10-CM codes come from the CDC National Center for Health Statistics (NCHS), the official US source. Data is updated annually. We provide search and browse by chapter for reference only—not as a replacement for professional coding guidance.

Question 35

What does "billable" mean for ICD-10 codes?

Accepted Answer

A billable (or "valid for billing") code is a leaf-level code that can be used on claims. Non-billable codes are category headers that require a more specific sub-code. For example, E11 is a category; E11.9 is a billable code for Type 2 diabetes.

Question 36

How do I search for an ICD-10 code?

Accepted Answer

On usnpi.com/icd10, type a diagnosis term (e.g. "diabetes") or a code (e.g. "E11.9") in the search box. Results show matching codes with descriptions. You can also browse by chapter to explore the full classification.

Question 37

What are marketplace insurance plans?

Accepted Answer

Marketplace insurance plans are health insurance plans sold through Healthcare.gov (the federal health insurance marketplace). They include Bronze, Silver, Gold, and Platinum metal levels. Plans are offered by qualified insurers and must cover essential health benefits. On usnpi.com you can browse plans by state or ZIP code.

Question 38

Where does usnpi.com get insurance plan data?

Accepted Answer

Our insurance plan data comes from the Healthcare.gov public data. We display plan details including premiums, deductibles, benefits, and service areas. For enrollment and exact pricing for your situation, use Healthcare.gov directly.

Question 39

What is a HIOS Plan ID?

Accepted Answer

HIOS (Health Insurance Oversight System) Plan ID is a unique identifier assigned by CMS to each health insurance plan in the federal marketplace. It looks like 12345AZ001-01-02. You can use the HIOS Plan ID to look up a plan on usnpi.com or add it to our Plan Comparison tool.

Question 40

What do metal levels (Bronze, Silver, Gold, Platinum) mean?

Accepted Answer

Metal levels indicate how costs are split between you and the plan. Bronze plans have lower premiums but higher out-of-pocket costs. Silver balances premium and cost-sharing. Gold and Platinum have higher premiums but lower deductibles and copays when you use care.

Question 41

What is deductible and maximum out-of-pocket (MOOP)?

Accepted Answer

The deductible is the amount you pay for covered services before the plan starts paying. MOOP (maximum out-of-pocket) is the most you pay in a year for covered services—after that, the plan pays 100%. Both vary by plan and metal level.

Question 42

How do I compare insurance plans?

Accepted Answer

Use our Plan Comparison tool at usnpi.com/tools/insurance-plan-compare. Add up to 4 plans by entering their HIOS Plan IDs. You can compare monthly premium, metal level, deductible, MOOP, HSA eligibility, and quality rating side-by-side.

Question 43

What is the difference between Doctors and Providers?

Accepted Answer

"Doctors" refers specifically to physicians (MD, DO) and similar medical professionals. "Providers" is a broader term that includes all healthcare entities—individuals (doctors, nurses, therapists) and organizations (hospitals, clinics, agencies).

Question 44

What types of healthcare organizations are on usnpi.com?

Accepted Answer

We list: Hospitals, Nursing Homes, Hospices, Home Health Agencies, and Help Agencies. Each type serves different patient needs—from acute care to long-term care, end-of-life care, and in-home services.

Question 45

What do common medical credentials mean?

Accepted Answer

MD (Doctor of Medicine) and DO (Doctor of Osteopathic Medicine) are physician degrees. NP (Nurse Practitioner) and PA (Physician Assistant) are advanced practice roles. PT (Physical Therapist), OT (Occupational Therapist), and RN (Registered Nurse) indicate specialized nursing or therapy credentials.

Question 46

What do different credentials mean for specialists?

Accepted Answer

Specialists add credentials like FACS (Fellow of the American College of Surgeons), FACP (Fellow of the American College of Physicians), or subspecialty certifications (e.g., Cardiology, Dermatology). These indicate advanced training and expertise in a specific area of medicine.

Question 47

How can I verify a provider's credentials?

Accepted Answer

Use usnpi.com to look up a provider by NPI and view their taxonomy, licenses, and identifiers. For official verification, check your state medical board website, the NPPES registry at npiregistry.cms.hhs.gov, or specialty board directories like abms.org.

Question 48

What is board certification and why is it important?

Accepted Answer

Board certification means a provider has met additional standards beyond basic licensure, including exams and ongoing education. It indicates expertise in a specialty. Board-certified providers are recognized by organizations like the American Board of Medical Specialties (ABMS).

Question 49

Why are credentials important?

Accepted Answer

Credentials indicate a provider's education, training, and qualifications. They help patients understand what type of care a provider can offer and verify that the provider meets professional standards.

Question 50

How do I choose the right healthcare provider?

Accepted Answer

Consider your needs: specialty required, location, insurance acceptance, and patient reviews. Use usnpi.com to search by specialty and location, verify credentials and licenses, and read patient reviews. Check if the provider accepts your insurance and whether they accept new patients.

Question 51

What questions should I ask when scheduling an appointment?

Accepted Answer

Ask about: new patient availability, insurance acceptance, what to bring (ID, insurance card, medical records), cancellation policy, and whether telehealth is available. Confirm the provider's credentials and specialty match your needs.

Question 52

How do I prepare for my first visit to a new provider?

Accepted Answer

Gather your medical history, current medications, insurance information, and a list of questions or symptoms. Arrive early to complete paperwork. Bring a family member if helpful. Write down key health dates (surgeries, diagnoses) and any allergies.

Question 53

What should I bring to a medical appointment?

Accepted Answer

Bring: photo ID, insurance card, list of current medications and dosages, medical records from previous providers (if transferring care), and a list of questions or concerns. For specialists, bring referral forms if required by your insurance.

Question 54

How do I transfer medical records to a new provider?

Accepted Answer

Contact your current provider's office and request a records release form. Sign the authorization and specify which records to send and where. Records can be sent electronically, by mail, or you may receive a copy to bring. Allow 1–2 weeks for processing. There may be a fee for copies.

Question 55

What is hospital quality and patient experience data?

Accepted Answer

It is standardized, publicly reported information from the Centers for Medicare & Medicaid Services (CMS), mainly aligned with Medicare Care Compare and the CMS Provider Data Catalog. It covers how patients rate their stay (HCAHPS), safety (e.g. healthcare-associated infections), clinical outcomes (complications and mortality), unplanned returns to the hospital, and whether hospitals deliver timely, evidence-based care. The goal is to help you compare hospitals on dimensions that matter to consumers and to encourage hospitals to improve.

Question 56

What is HCAHPS?

Accepted Answer

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the first national, standardized survey of patients' perspectives of hospital care in the United States. CMS has used it since 2008 so hospitals can be compared fairly. It asks about communication with nurses and doctors, responsiveness of staff, cleanliness, quietness, medicines, discharge instructions, overall rating, and whether patients would recommend the hospital. CMS developed it with the Agency for Healthcare Research and Quality (AHRQ) using rigorous testing.

Question 57

Who gets the HCAHPS survey?

Accepted Answer

A random sample of adult patients who had a recent hospital stay—not only Medicare beneficiaries. Hospitals may contact patients between about 48 hours and six weeks after discharge by mail, phone, web, or a combination. Your individual answers are combined with others; public results show aggregated percentages and star ratings, not individual responses.

Question 58

What do patient survey star ratings mean?

Accepted Answer

CMS summarizes HCAHPS results into 1–5 star ratings for patient experience on Care Compare (and related public data). More stars generally mean higher shares of patients reporting positive experiences on the underlying survey items. Stars are one part of the picture; also read the specific measure percentages and footnotes for context.

Question 59

What are healthcare-associated infections (HAI)?

Accepted Answer

HAIs are infections patients can develop while receiving care for other conditions (for example, certain surgical site or bloodstream infections tracked by CMS). On hospital profiles, lower infection rates relative to expectations are better. CMS compares each hospital to national benchmarks and may label results as better, no different, or worse than the national rate.

Question 60

What does "Compared to national" mean?

Accepted Answer

For many safety and outcome measures, CMS assigns a simple three-level comparison to the national benchmark: Better, No different, or Worse. It reflects statistical comparison to the national value, not a judgment about every patient's experience. Always read footnotes—small patient counts or suppression rules can hide or limit reported results.

Question 61

What are unplanned visits and readmissions?

Accepted Answer

These measures track how often patients return to the hospital (or emergency department, depending on the measure) within a defined period after discharge when that return was not planned—for example, readmission after heart failure. Lower rates often suggest smoother discharge planning and follow-up, though patient mix and community factors also play a role.

Question 62

What is timely and effective care?

Accepted Answer

These are process measures: how often the hospital followed recommended steps for specific conditions (such as heart attack, stroke, pneumonia, or surgery)—for example, giving aspirin at the right time or starting antibiotics quickly when appropriate. A higher score usually means the hospital delivered the recommended care more consistently. They reflect processes, not every possible outcome.

Question 63

Why is some quality data missing for a hospital?

Accepted Answer

CMS may suppress or omit measures when there are too few eligible cases, the hospital is new, data did not meet reporting standards, or privacy rules apply. Footnote codes on official CMS data explain many of these cases. Missing data does not necessarily mean poor quality.

Question 64

How current is quality data on usnpi.com?

Accepted Answer

Figures come from CMS public datasets and are updated as CMS publishes new reporting periods. There is often a lag between when care was delivered and when results appear. Check the period dates shown with each measure on the hospital page.

Frequently Asked Questions

Table of Contents

NPI (National Provider Identifier)

Provider Licenses

Provider Identifiers (Insurance & Program Numbers)

Medicare vs Medicaid

Taxonomy Codes

HCPCS Codes

ICD-10 Codes

Insurance Plans

Provider Types

Credentials

Choosing a Provider

Quality & patient experience

About usnpi.com

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