NPPES verification

NPI, taxonomy, practice address, sole proprietor status.

Every 24h Primary source — no aggregator Authority site

Issuing authority: Centers for Medicare & Medicaid Services (CMS)

What we verify

NPI number (Type 1 individual)

Legal name and credentials suffix

Primary taxonomy code and specialty

Practice and mailing addresses

Sole proprietor status

Enumeration date and last update date

Verification rules

How we decide pass / flag / block

01
NPI must be active and Type 1 for the individual provider.
02
Legal name must match the attested name (allow case/diacritic normalization).
03
Primary taxonomy must map to an ABMS or AOA-recognized specialty for board-eligible claims.
04
Deactivation reason, if present, blocks the credential until reinstated.

Example evidence

Example NPPES response (excerpt)

Stored alongside the credential with source URL, raw payload hash, and timestamp. Names and IDs below are illustrative.

Verified payload (excerpt)

npi

1356481364

enumeration_type

NPI-1

status

A (Active)

first_name / last_name

JANE / RIVERA

credential

primary_taxonomy

207R00000X — Internal Medicine

last_updated

2026-05-14T08:11:00Z

Refresh cadence

Every 24h

NPPES is re-queried every 24 hours. Any change to status, taxonomy, or name triggers an immediate re-verification and notifies any organization holding an active packet.

Source-down handling

When the authority is unreachable

If NPPES is unreachable, the NPI field is marked stale with the last successful timestamp. We never substitute a cached snapshot as a fresh verification.

Next source

CAQH ProView

Council for Affordable Quality Healthcare