Provider & NPI Lookup Tool
Search 7M+ federal provider records by name or NPI, then walk the free verification workflow below. Every figure is drawn from the federal National Provider Identifier Registry (CMS NPPES) - more than 7 million providers, maintained since May 2007, with 2023 Medicare Part D data, and, according to CMS, can be searched, compared, and traced in our methodology.
Health-information notice: This tool surfaces public federal data and points you to official verification sources. It is not medical advice, a rating, or a recommendation. Confirm any clinical decision with the provider directly and with your own physician.
What this tool covers
Every U.S. healthcare provider who bills Medicare or Medicaid has a free, public federal record, this tool finds it and points you to the official sources that confirm license, board certification, and disciplinary history.
What this tool searches
The federal registry behind the lookup
- 7,090,243
- Providers tracked
- 690
- Specialty types
- 56
- States & territories
Use this page to look up any U.S. healthcare provider by name or 10-digit National Provider Identifier (NPI), then walk through a free, federally-sourced verification workflow before you rely on any directory listing, including this one, for a healthcare decision. PlainDoctor is a directory of publicly published CMS NPPES records; it is not a license-status engine, a malpractice database, or a quality scoring service. Verifying licensure and board certification on the appropriate official sources is always the last-mile step.
The workflow below mirrors the protocols used by hospital credentialing offices, payer enrollment teams, and state Medicaid programs. Every link points to an official government or recognized certifying-body source. None of these checks cost money; none require you to disclose your own identity to the provider.
What a lookup can verify
Every provider has a record, not every record runs deep
All 7,090,243 providers in the registry carry a base CMS NPPES record. The deeper verification layers below, prescribing, payments, affiliations, quality scores, exist for a smaller share, so a lookup returns more for some providers than others.
- NPPES registry record 100% 7,090,243
Name, NPI, specialty, practice address, every enrolled provider.
- Hospital / facility affiliation 19.6% 1,389,477
Where the provider practices, from CMS care-setting data.
- Medicare Part D prescribing 19.3% 1,370,886
Claim volume, brand-vs-generic mix and opioid rates.
- Open Payments (industry) 13.8% 979,136
Payments from drug and device makers (Sunshine Act).
- MIPS quality score 6.7% 477,587
CMS Merit-based Incentive Payment System final score.
Share of the 7,090,243-provider NPPES registry carrying each layer. Source: CMS NPPES, the Medicare Part D Prescriber file, Open Payments, CMS affiliations, and MIPS, current release.
Step 1: Search PlainDoctor
Use the search above to find the provider in our directory by name, NPI, specialty, or city. This pulls the underlying NPPES record and links to specialty and state context, the starting point for every check below.
Dr. Jane A. Rivera, MD
- Primary taxonomy
- 207R00000X, Internal Medicine
- Medicare Part D
- 4,812 claims · 612 beneficiaries
- Enumerated
- 2009 (NPI issued)
- Next step
- Verify license & board status below
Illustrative layout only, real results render the live CMS NPPES fields for the provider you search.
Step 2: Five-step verification workflow
Run through each step. Stop at any step that returns a discrepancy and contact the provider's office directly before scheduling care.
-
NPI exists and matches the provider's legal name
The federal starting point, name, specialty, practice address.
CMS NPI Registry -
Active, unrestricted state license + disciplinary history
Or your state's nursing / dental / behavioral-health board.
FSMB State Medical Board directory -
Board certification (MDs)
Confirms specialty board exams beyond basic licensure.
ABMS Certification Matters -
Medicare participation & assignment status
Whether the provider accepts Medicare assignment.
Medicare.gov Care Compare
Step 3: Read the NPPES record carefully
NPPES fields are self-reported by the provider at NPI enrollment and are not actively audited by CMS. The table below explains what each field can and cannot tell you.
NPI
A unique, lifetime federal identifier issued by CMS for billing
Quality, training, board status, or active license
Primary taxonomy (NUCC)
The provider's self-declared primary specialty category
Board certification or fellowship training
Practice address
Most recent address the provider submitted to CMS
Whether that location is currently accepting new patients
Credential (MD, DO, NP…)
Self-declared post-nominal letters
A verified academic degree (verify via state board or NSC)
Enumeration date
When the NPI was first issued (proxy for time billing CMS)
Years of clinical experience or current activity level
Step 4: When the data does not match
Different practice address than expected
NPPES is refreshed monthly; many providers do not update CMS promptly after moving. Call the office to confirm the current location.
Inactive or revoked license on the state board
Do not schedule care until the discrepancy is explained. License status takes precedence over any directory listing.
No board certification found on ABMS / AOA
Board certification is voluntary. Many credentialed providers practice safely without it; some specialties certify through other recognized bodies.
NPI not found
Re-enter the 10-digit number and confirm with the provider. A truly missing NPI is unusual for anyone who bills Medicare or Medicaid.
Frequently asked questions
Is an NPI proof of board certification?
Can I tell from PlainDoctor whether a provider has been disciplined?
What does the NUCC taxonomy code mean?
Is this tool a substitute for medical advice?
Sources: CMS NPPES NPI Registry (npiregistry.cms.hhs.gov); FSMB (fsmb.org); ABMS (certificationmatters.org); AOA (certification.osteopathic.org); NUCC (nucc.org); Medicare.gov Care Compare. PlainDoctor is a directory; the official sources above are the authoritative records for licensure and certification status. Methodology · About
After you find the NPI record
An active NPI is step one of three, finish the verification.
- Confirm the state medical license and any board actions with the state board, the NPI registry does not carry license status. Verification guide
- Review the provider’s full PlainDoctor profile for Medicare volume, prescribing patterns, and quality-program scores. Open a profile
- Choosing between two candidates? Put them side-by-side on the same federal metrics. Compare providers
Lookup results mirror the official CMS NPPES registry; providers maintain their own records, so addresses and affiliations can lag.
Disclaimer: Data from CMS NPPES and Medicare Part D. PlainDoctor does not rate or rank providers. Provider information is self-reported and may not be current. Always verify information directly with the provider. About · Methodology