Credentialing Glossary

National Plan and Provider Enumeration System

credentialing

Definition

The official name for NPPES — the CMS system that assigns and manages NPI numbers for all healthcare providers and health plans in the United States.

Extended Explanation

The National Plan and Provider Enumeration System is the full name of NPPES, the system where every healthcare provider in the United States registers for their NPI number. Most people just say "NPPES" or "the NPI registry." NPPES is run by CMS and serves as the authoritative source for provider identification data. When a payer verifies your NPI during credentialing, they are checking against NPPES. When a pharmacy verifies your prescribing authority, they look up your NPI in NPPES. When a patient searches for a provider in a directory, the underlying data often comes from NPPES. Registering in NPPES is free and mandatory for any provider who transmits electronic healthcare transactions. The registration can be done online at nppes.cms.hhs.gov. You will need your Social Security number, your state license information, your taxonomy code, and your practice location details. NPPES assigns two types of NPIs. Type 1 is for individual providers. Type 2 is for organizations. Each NPI is unique and permanent. It follows you throughout your career and never changes, even if you move states, change specialties, or switch practice settings. Keeping your NPPES record current is critical. Payers and other entities regularly pull data from NPPES for verification. If your NPPES record shows an old address, an outdated taxonomy code, or a phone number that does not work, it creates discrepancies that delay credentialing. NPPES data is public. The NPI registry is searchable by anyone. CMS also publishes a downloadable data file of all NPI records, which is used by healthcare organizations, researchers, and technology companies. Your practice address, phone number, and specialty as listed in NPPES are publicly visible. If you need to update your NPPES record, log in at nppes.cms.hhs.gov. Changes are typically reflected within a few business days. If you have lost access to your NPPES account, contact the NPI Enumerator at 1-800-465-3203.
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