1. Where is the NPPES data dissemination policy
conveyed?
The Centers for Medicare & Medicaid Services (CMS)
will be publishing a Notice (CMS-6060-N) in the
Federal Register on May 30, 2007. The Notice describes the
policy by which CMS will disclose certain health care provider data
that are contained in the NPPES.
2. What NPPES data will CMS disclose?
CMS will disclose health care provider data that
are required to be disclosed under the Freedom of Information Act
(FOIA). The list of FOIA-disclosable data elements is included
in the Notice. We will not be disclosing a health care provider's
Social Security Number (SSN), Internal Revenue Service (IRS)
Individual Taxpayer Identification Number (ITIN), or date of
birth.
3. How will CMS make the FOIA-disclosable NPPES
data available?
CMS will make the NPPES health care provider data that
are required to be disclosed under FOIA publicly available in two
ways: (a) in an initial file that users can download from the
Internet (monthly update files will also be available for
download); and (b) in a query-only database whereby a user can
search for a health care provider's NPPES data by entering an NPI
or the name of a health care provider.
4. Is there a charge to obtain the FOIA-disclosable
NPPES health care provider data?
There is no charge to download the NPPES file or its
monthly updates, or to use the query-only database.
5. I want FOIA-disclosable data for only the
physicians in New York and I want the data on a CD. How do I go
about having my request fulfilled?
The Notice explains that entities who would like more or less data
than what are available in the downloadable files or in the
query-only database, or who would like data in different formats or
on different media, must submit requests under the FOIA to the CMS
FOIA Office either in writing or by fax machine. There may be
a charge to the requester for CMS to furnish data under
FOIA. The address and fax number are as follows:
Address:
Centers for Medicare & Medicaid Services
Office of Strategic and Regulatory Affairs, Freedom of Information
Group
Room N2-20-16
7500 Security Boulevard
Baltimore, MD 21244-1850
Fax number:
(410) 786-0474
6. I am a physician. Now that my FOIA-disclosable
NPPES information is available to anyone who chooses to download
the file or query the database, do I need to respond to requests
from hospitals, doctors' offices, laboratories, durable medical
equipment (DME) suppliers, or pharmacies who want me to disclose my
NPI so they can use it in their claims to identify me as a
referring physician, a physician who ordered tests or medical
equipment/supplies, or a physician who prescribed
medication?
If you are a covered health care provider, you are required by the
NPI Final Rule to disclose your NPI to any entity who requests it
for use in HIPAA standard transactions. The publication of the
NPPES Data Dissemination Notice does not absolve covered health
care providers from that requirement. With the public availability
of certain NPPES health care provider data, however, we expect such
requests to greatly diminish and perhaps discontinue entirely.
7. When will the FOIA-disclosable NPPES health care
provider data be available?
The data will be available 30 days after the date the Notice is
published in the Federal Register.
8. How will I know where to find the NPPES
downloadable file, its monthly updates, and the query-only
database?
Prior to the data being available, CMS will post an
announcement on the CMS NPI web page (www.cms.hhs.gov/NationalProvIdentStand/)
that will contain the locations of the downloadable files and the
query-only database. Neither the initial downloadable file nor
the query-only database will be available until 30 days after the
publication date of the NPPES Data Dissemination Notice.
9. How many different health care providers can I
enter into the NPPES query-only database in one
session?
A user can query only one NPI or one provider name at a time, but
there is no limit to the number of queries a user can enter in any
given session.
10. What should a health care provider do if its
NPPES data that are displayed in the downloadable file and the
query-only database are not correct?
Health care providers who notice that their records are incorrect
may update their information in NPPES at any time. They may
access NPPES (https://nppes.cms.hhs.gov/NPPES) by
using the UserIDs and passwords they already established and submit
their updates via the web. If a health care provider has not
established a UserID and password for NPPES, that health care
provider may do so by going to NPPES (https://nppes.cms.hhs.gov/NPPES) and
then submitting the update via the web. If a health care provider
prefers to submit an update on paper, the health care provider
should contact the NPI Enumerator and request a paper NPI
Application/Update Form and submit the updates on that
form. The NPI Enumerator can be reached by calling
1-800-465-3203, sending an e-mail to customerservice@npienumerator.com, or
writing to: NPI Enumerator, P.O. Box 6059, Fargo, ND
58108-2101. Health care providers who are covered entities
under HIPAA are required by the NPI Final Rule to update their
NPPES data within 30 days of the effective date of the
change. Other health care providers who have been assigned
NPIs are encouraged to do the same. By doing this, the information
in NPPES remains current.
11. If a health care provider deactivates its NPI,
will its record still be in the downloadable file and the
query-only database?
How will it be known that the NPI was deactivated?
The record will be included in the downloadable file and the
query-only database. The record, when displayed in the
downloadable file and the query-only database, will contain all of
the NPPES health care provider data that are required to be
disclosed under the FOIA. The fact that the NPI has been
deactivated will be known because there will be information in the
NPI Deactivation Date and NPI Deactivation Reason Code.
12. Will it be difficult to download the
downloadable file?
The initial downloadable Zip file, as well as each monthly update
Zip file, is a compressed archive file that will contain a file
layout and the NPPES health care provider data that are
FOIA-disclosable. It is intended that the data be imported
into a relational database, or otherwise manipulated, by
individuals with the requisite technical expertise. There is
no Help Desk or other technical support available from CMS or the
NPI Enumerator for downloading or using this file.
13. I am unable to locate a specific health care
provider in the downloadable file or in the query-only
database. Why is that?
If the health care provider did not apply for an NPI, or
if the application was rejected and the health care provider did
not re-apply and subsequently obtain an NPI, there will be no
record.
