NPI Validation verifies the status of a National Provider Identifier (NPI) through the National Plan & Provider Enumeration System (NPPES). This service confirms whether an NPI is active, deactivated, or not found, providing detailed or minimal data as applicable. NPI Validation does not check exclusion statuses, but it enhances provider/entity identification during exclusion monitoring. Results are displayed in Passport under specific severities (Active, Deactivated, Not Found). Only standard 10-digit NPIs are accepted. For further details on result severities and how NPI Validation integrates with monitoring services, refer to this article.
What is an NPI Validation?
NPI Validation is a service that verifies the status of a National Provider Identifier (NPI) using the National Plan & Provider Enumeration System (NPPES), also known as CMS Data Dissemination.
This service specifically checks the status of the NPI number and does not address a provider's exclusion status. For exclusion-related results, Exclusion Monitoring is a separate service that identifies any exclusions associated with a provider or vendor but does not verify the provider's NPI status. Adding NPI data can improve provider/entity identification during exclusion monitoring, much like including a date of birth (DOB) or home address.
When a provider/entity has NPI Validation monitoring, the system always generates a monitoring result in Passport for the NPI entered, similar to how License Verification or SSDMF works.
NPI Validation Result Severities
The following severities are available for NPI validation in Passport:
- Active (Green Result Status): The NPI is found on NPPES and the status is active. The alert result will display the detailed provider data that NPPES maintains on Active NPIs including information like name, address, and other practice information.
- DeActivated (Red result Status): The NPI is found on NPPES and the status is deactivated. The alert result will display only the minimal data that NPPES maintains on deactivated NPIs, the deactivation date.
- Not Found (Red result status): NPI cannot be found on NPPES at all.
- Passport does not allow entry of an NPI outside of the 10-digit standard NPI format.