How To: Perform an Instant Search Using NPI

Summary

This article explains how ProviderTrust’s Instant Searches by NPI return matches across exclusions, Medicare Opt-Out, NPI validation, and the CMS Preclusion List. Results are color-coded for clarity, with details available for each issue. NPI searches require a valid 10-digit identifier, and results vary by contracted monitoring services. The CMS Preclusion List is an additional product requiring a Delegation Agreement and a client-provided list.

Overview

Organizations contracted for Instant Searches can perform National Provider Identifier (NPI)-based searches to identify matches across multiple federal and state data sources. Results depend on your organization’s contracted monitoring services, and some products—such as the CMS Preclusion List—require additional agreements.

Available NPI Matches

When searching by an NPI, you may receive exact matches for: 

• Federal Exclusions
• State Exclusions
• Medicare Opt-Out
• NPI Status
• CMS Preclusion List**

*Available instant search results depend on your organization’s contracted monitoring services.
**The CMS Preclusion List is not part of the Exclusion Monitoring package; it requires a Delegation Agreement and the CMS Preclusion List from the client.

How to Search by NPI

To perform an NPI search:

1. Enter the 10-digit NPI number (numerical digits only) into the NPI Search field.

2. If the number is improperly formatted, the following warning message will be displayed: "Please enter a valid 10-digit NPI."

3. Click "Search" button

NPI Matched Result Types

Federal & State Exclusions

• Matches are indicated in red as Issue Found.

• Federal results include both OIG and SAM sources. Multiple exclusions display as individual issues.

Details regarding the exclusion can be accessed by clicking the arrow on the right side of the result (see image above)

Details from the exclusion source will be provided and can include the following:

First Name
Middle Name
Last Name
City
Address
Type
Excluded Date
Exclusion Notes
*Please note: Details provided will vary based on the exclusion source.

• State exclusion results appear the same way, with multiple results stacking individually.

If no state exclusions are found, a green "Clear" status displays as All other states.

NPI Validation

NPI status results are nested under "Other Exclusions". There are two NPI validation statuses you may receive:

1. No Issue Found (green)

2. Inactive (red)

• An Inactive status means that NPPES has deactivated the NPI number associated with this individual. 

3. Not Found (red) 

• The NPI number input into the search field could not be found on NPPES

Medicare Opt-Out

If an Opt-Out match is found while performing an NPI search, it will be indicated in red as Issue Found. Opt Out results are nested under "Other Exclusions". 

Details regarding the Opt Out alert can be accessed by clicking the arrow on the right side of the result. Details for the result can include the following:

Person Name
Specialty
Effective Date
End Date
Address
Opt Out ID

CMS Preclusion**

• Matches display in red as Issue Found under Other Sources.

**The CMS Preclusion List is not part of the Exclusion Monitoring package; it requires a Delegation Agreement and the CMS Preclusion List from the client.