NPI Number Instant Lookup
NPI and Exclusion List Frequently Asked Questions
What is the National Plan and Provider Enumeration System (NPPES)?
Who is required to have a National Provider Identifier (NPI)?
According to the Centers for Medicare and Medicaid Services (CMS), there are two types of healthcare providers in terms of NPI – Type 1 and Type 2.
Type 1 NPI Providers: Healthcare providers who are individuals, including physicians, dentists, and all sole proprietors. An individual is eligible for only one NPI.
Type 2 NPI Providers: Healthcare providers which are organizations, including physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself.
What is a healthcare exclusion and an exclusion list?
There are two federal exclusion databases: 1) the Office of the Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) and 2) the General Services Administration System for Award Management’s (GSA SAM.gov) exclusion list. Additionally, there are 44 state Medicaid/Medicare exclusion lists.
An excluded individual or entity is ineligible to receive any money (directly or indirectly) from federal healthcare programs like Medicare or Medicaid. Parties can be excluded for several reasons ranging from financial fraud to patient abuse.
Learn about the differences amongst exclusion lists and how and how they maintain their databases.
What is the Medicare Opt Out List?
What is the CMS Preclusion List?
The CMS Preclusion List shows the providers and prescribers who are precluded from receiving payment for Medicare Advantage (MA) items and services or Part D drugs furnished or prescribed to Medicare beneficiaries.
