Overview
The National Provider Identifier (NPI) is a unique 10-digit identification number issued to healthcare providers by the Centers for Medicare & Medicaid Services (CMS). AllCare uses NPI verification to validate provider identity and auto-populate profile information.What is NPPES? The National Plan and Provider Enumeration System (NPPES) is the CMS database containing over 1.5 million provider records. AllCare queries this database to verify NPIs and retrieve provider information.
NPI Types
There are two types of NPIs:| Type | Name | Description | Examples |
|---|---|---|---|
| Type 1 | Individual | Assigned to individual healthcare providers | Physicians, NPs, PAs |
| Type 2 | Organization | Assigned to healthcare organizations | Clinics, hospitals, group practices |
AllCare primarily works with Type 1 (Individual) NPIs for provider registration.
How NPI Lookup Works
The Lookup Process
1
Enter NPI
Enter the provider’s 10-digit NPI in the registration form
2
System Validates Format
AllCare validates that the NPI:
- Is exactly 10 digits
- Contains only numbers
- Passes the Luhn checksum algorithm
3
Query NPPES Database
If format is valid, the system queries the NPPES reference database
4
Return Provider Data
If found, provider information is returned and auto-filled into the form
Information Retrieved from NPPES
When an NPI is found, the following information can be automatically populated:Personal Information
| Field | Description |
|---|---|
| First Name | Provider’s first name as registered |
| Last Name | Provider’s last name as registered |
| Middle Name | Provider’s middle name (if available) |
| Name Prefix | Title (Dr., Mr., Ms., etc.) |
| Name Suffix | Suffix (Jr., Sr., III, etc.) |
| Credentials | Professional credentials (MD, DO, NP, PA-C) |
| Gender | Provider’s gender |
Contact Information
| Field | Description |
|---|---|
| Phone Number | Primary practice phone |
| Fax Number | Practice fax number |
| Address Line 1 | Street address |
| Address Line 2 | Suite/unit (if applicable) |
| City | City |
| State | State (2-letter code) |
| Zip Code | Postal code |
Professional Information
| Field | Description |
|---|---|
| Provider Type | Type of healthcare provider |
| Specialty | Primary specialty area |
| Sub-Specialty | Secondary specialty (if applicable) |
| Primary License Number | State license number |
| Primary License State | State of licensure |
| Certification Date | When NPI was certified |
Organization Information (Type 2 NPIs)
| Field | Description |
|---|---|
| Organization Name | Legal organization name |
| EIN | Employer Identification Number |
| Is Sole Proprietor | If individual operating as organization |
| Is Organization Subpart | If part of larger organization |
NPI Validation Rules
Format Requirements
Luhn Checksum Algorithm
The last digit of an NPI is a check digit calculated using the Luhn algorithm. This helps detect typos and invalid numbers.Common Lookup Results
Successful Lookup
When an NPI is found:- Form fields are automatically populated
- Provider can review and adjust any information
- Registration can proceed
NPI Not Found
What to do if NPI is not found
What to do if NPI is not found
Possible reasons:
- NPI was entered incorrectly
- Provider is newly registered (NPPES updates may take time)
- Provider has not yet obtained an NPI
- NPI has been deactivated
- Verify the NPI with the provider
- Check the NPPES NPI Registry directly
- If valid but not in AllCare’s database, enter information manually
- If provider doesn’t have an NPI, they must register at NPPES
Invalid Format
What to do if NPI format is invalid
What to do if NPI format is invalid
Common issues:
- Missing digits (entered 9 digits instead of 10)
- Extra characters (spaces, dashes, letters)
- Checksum failure (possible typo)
- Remove any spaces or dashes
- Count digits to ensure exactly 10
- Verify number with the provider
- Try the lookup again
Verifying Provider Identity
NPI lookup is one layer of provider verification. Additional verification may include:| Verification Type | Description |
|---|---|
| DEA Verification | Confirming DEA registration for controlled substance prescribing |
| State License | Verifying active state medical license |
| Board Certification | Confirming specialty board certifications |
| Identity Proofing | In-person or remote identity verification (for EPCS) |
Troubleshooting
'NPI must be exactly 10 digits' error
'NPI must be exactly 10 digits' error
Cause: The NPI entered is not 10 characters or contains non-numeric characters.Solution:
- Remove any spaces, dashes, or special characters
- Verify you have all 10 digits
- Re-enter the NPI
'NPI not found in NPPES database' error
'NPI not found in NPPES database' error
Cause: The NPI does not exist in the NPPES reference database.Solution:
- Verify the NPI is correct by checking with the provider
- Search the official NPPES Registry
- If the NPI is valid but not found, enter provider information manually
Information from lookup is outdated
Information from lookup is outdated
Cause: NPPES data may not reflect recent changes to provider information.Solution:
- Use the auto-filled data as a starting point
- Update any fields that have changed
- Provider should update their NPPES record at NPPES
Wrong provider returned
Wrong provider returned
Cause: NPI may have been entered incorrectly, returning a different provider.Solution:
- Verify the NPI number is correct
- Clear the form and re-enter the correct NPI
- Never proceed with incorrect provider information