Quick reference: U.S. credentialing authorities

How federal and state authorities interact

The CMS National Plan and Provider Enumeration System assigns a single 10-digit National Provider Identifier that follows a clinician across state moves and employer changes. The NPI is necessary for every Medicare and Medicaid claim, but it does not, by itself, confirm that the provider currently holds an active state license, that authorization is delegated to each state medical board under the Tenth Amendment. Browse PlainDoctor by state to see how providers register practice locations.

Why specialty board certification matters

Board certification by an American Board of Medical Specialties member board signals voluntary post-licensure examination and ongoing Maintenance of Certification cycles. It is not legally required to practice medicine, but health plans, hospital credentialing committees, and patients increasingly use it as a quality signal. View specialty-level data through PlainDoctor specialty pages showing certification rates by jurisdiction.

Reading disciplinary records responsibly

State medical board orders are public legal documents that describe the factual findings, conclusions of law, and disciplinary action taken. A single malpractice payment does not necessarily indicate poor practice, high-risk specialties (neurosurgery, obstetrics) have higher baseline payment rates than primary care. Patterns of multiple actions, license restrictions, or revocations are the meaningful signals to weigh. Read the PlainDoctor methodology for how disciplinary data integrates into provider profiles.

Step 1, How do you look up an NPI number?

The National Provider Identifier (NPI) is a unique 10-digit number assigned by CMS to every U.S. healthcare provider who bills Medicare or Medicaid. The NPI is issued through the National Plan and Provider Enumeration System (NPPES). Looking up an NPI is the first verification step because it confirms federal registration and provides key identifying details.

You can look up any provider's NPI at the official NPPES NPI Registry or use PlainDoctor's search tool, which indexes the same NPPES data. Search by provider name and state. The NPI record shows:

• Full legal name as registered with CMS
• Entity type: Type 1 (individual provider) vs Type 2 (organizational entity)
• Primary taxonomy code and specialty description
• Practice address and phone number (as self-reported)
• Enumeration date (when the NPI was first issued)
• Last update date (when the record was most recently modified)
• Additional taxonomy codes (secondary specialties)

The NPPES record does not confirm that a state license is currently active. It also does not flag disciplinary actions. Think of it as the foundational federal registry, it tells you the provider exists and is federally registered, but it does not do the full work of credential verification on its own.

Important: A provider whose NPI record shows a deactivation date may have had their NPI deactivated due to inactivity, retirement, or the practice closing. Verify active status through the state medical board if any question exists. You can also browse providers by state to find practitioners in your area.

Step 2, State Medical Board License Verification

A state medical board license is the legal authorization to practice medicine in a given state. Physicians must hold an active license in every state where they practice. Licenses can be active, inactive, expired, suspended, revoked, or subject to conditions, all of which are matters of public record.

Fastest national lookup: The Federation of State Medical Boards (FSMB) operates DocInfo.org, a free public database that aggregates physician license information from all 50 state medical boards and D.C. A basic search shows license status, state, and any public board actions. A more detailed report (fee-based) includes malpractice payment history.

Direct state board lookup: Every state medical board has a publicly accessible license verification tool on its website. These are authoritative because they come directly from the licensing authority. Common state board portals include:

• California: BreEZe (breeze.ca.gov)
• New York: NY License Verification (op.nysed.gov)
• Texas: Texas Medical Board (tmb.state.tx.us)
• Florida: Florida Health MQA (mqa.doh.state.fl.us)

For nurse practitioners, search the state nursing board (e.g., nysna.org for New York, bon.texas.gov for Texas). For physician assistants, search the state PA board or equivalent regulatory body.

When verifying, note the license expiration date. Many physicians renew licenses on a 2–3 year cycle. An "active" status confirms the license is in good standing at the time of your search. If you see any conditions or probationary status, click through to read the full board order, which is a public document.

Step 3, Board Certification Verification

Board certification is a voluntary credential that demonstrates a physician has met specialty-specific competency standards beyond the minimum required for licensure. Board-certified physicians have passed written and sometimes oral examinations administered by a specialty certifying board, and many must pass recertification exams every 7–10 years to maintain the credential.

For allopathic physicians (MDs): The American Board of Medical Specialties (ABMS) oversees 24 member boards covering all major physician specialties. Search the ABMS public verification tool at certificationmatters.org. The search is free and shows the physician's name, specialty, whether certification is current, and the certifying board. You can also search for subspecialty certification (for example, verifying that a cardiologist holds additional certification in Interventional Cardiology from the ABIM).

For osteopathic physicians (DOs): The American Osteopathic Association (AOA) administers board certification through its member specialty boards. Verify certification at osteopathic.org. Note that many DOs hold dual certification from both ABMS and AOA boards.

For nurse practitioners: The American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners Certification Board (AANPCB) are the main NP certifying bodies. Verify NP certification at nursingworld.org (ANCC) or aanpcert.org (AANPCB).

For physician assistants: The National Commission on Certification of Physician Assistants (NCCPA) certifies PAs. Verify at nccpa.net. The NCCPA also administers Certificate of Added Qualifications (CAQ) for subspecialties.

Board certification is particularly relevant when you need a specialist. Confirming that a cardiologist is ABIM-certified in Cardiovascular Disease, or that a surgeon holds the appropriate board certification in their specialty, provides meaningful assurance of expertise.

Step 4, Disciplinary Action and Malpractice History

Disciplinary actions by state medical boards are matters of public record. Common reasons for disciplinary action include substance abuse, sexual misconduct, fraudulent billing, practicing outside the scope of training, and violations of standard of care. Actions range from letters of concern to license suspension or revocation.

DocInfo.org (FSMB) is the primary aggregated source for disciplinary information. The free search shows active board actions. The paid comprehensive report ($9.95 as of 2024) includes malpractice payment reports submitted by insurance companies to the NPDB (National Practitioner Data Bank).

The National Practitioner Data Bank (NPDB) is a federal database maintained by the Health Resources and Services Administration (HRSA) that collects reports of malpractice payments, adverse licensure actions, and other professional disciplinary information. The NPDB is not directly searchable by the public, only hospitals, health plans, and certain other authorized entities can query it. However, malpractice payment data reported to the NPDB flows through to the FSMB's DocInfo.org comprehensive report.

State board websites typically maintain public order databases where you can search for disciplinary orders against specific licensees. These orders are legal documents that describe the factual findings and disciplinary action taken.

Court records for civil malpractice lawsuits are separate from board actions. Most lawsuits settle confidentially and are not in public databases, though some become matter of public record. You can search federal court records through PACER and state court records through each state's court system website.

It is worth noting that having one malpractice payment does not necessarily indicate poor practice, medicine involves difficult cases and imperfect outcomes, and some providers practicing in high-risk specialties may have malpractice history without being unsafe. Patterns of multiple payments, board sanctions, or license restrictions are more meaningful signals.

Putting It All Together

A thorough credential check takes about 15–20 minutes and uses four separate databases:

• NPPES NPI Registry (npiregistry.cms.hhs.gov or PlainDoctor search) - Confirm federal registration, specialty, and contact information
• DocInfo.org or state medical board, Confirm active state license and check for disciplinary actions
• ABMS certificationmatters.org or AOA/ANCC/NCCPA, Confirm board certification is current
• DocInfo.org comprehensive report (optional, fee-based) - Check malpractice payment history

For most routine provider selection decisions, checking the NPI registry, license status, and board certification is sufficient. The malpractice payment report is most relevant when choosing a surgeon or specialist for a significant procedure.

Browse our specialty directory to search providers by specialty, or look up a specific provider by name using PlainDoctor's search tool to find their NPI, specialty, and practice location as a starting point for further verification.

Frequently Asked Questions