Page History

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• NPPES was created as the authoritative database for the National Provider Identifier (NPI) for individuals and organizations.
• NPPES was not designated as a provider directory, and much of the information contained in NPPES grows stale. However, many Federal Agencies still look to NPPES for critical provider information.
• A real-time query application program interface (API) to NPPES is being rolled out in 2016 to supplement the current public access to full NPPES database downloads via a standardized flat file format. Some organizations (including Michigan) have integrated with the pilot implementation.
• Several organizations have integrated NPPES data into their own provider directories, or have also created their own APIs to NPPES data, some of them based on the FHIR API framework.
• NPPES will add data integrity checks in 2017.
• Provider updates to information stored in NPPES are not enforced. However, provider updates to PECOS information to support Medicare are now mandatory. Updates to PECOS may be used to update information in NPPES if the provider requests it.
• Several Workshop participants called for NPPES as the centralized, national provider database that should be used as the baseline for provider directories.
• It was noted, however, that NPPES does not include entries for all providers that might be required by all provider directory use cases, that the information integrity of NPPES would have to be improved, and that many organizations were represented multiple times in NPPES. If used as the baseline, NPPES would have to be supplemented with additional information (e.g., electronic service endpoints, provider organizational relationships, health plan relationships) to meet many use cases.

See Appendix F, Provider Directory Workshop Materials, for more detail on the presented material and Workshop discussions.

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