NPI and PECOS Resources

What an NPI is, why HIPAA requires it, what it does and does not do, entity types, NPPES, and how NPI Profile uses the public data.

Individual vs. organizational NPIs, who needs both, the sole proprietor rule, incorporated individuals, and HIPAA subparts.

The three application paths (online, paper, EFI bulk), what to gather, what happens after applying, how to update, and how to deactivate.

Who must have an NPI to prescribe under Medicare Part D, the pharmacy claim flow, the cash-only exception, and compliance deadlines.

Which NPI fields are FOIA-disclosable, which are protected, how the monthly data file works, masked identifiers, and how NPI Profile uses it.

What Electronic File Interchange is, when to use it vs. individual applications, EFIO registration, CSV/XML formats, and processing lifecycle.

NPI, PTAN, Tax ID, DEA, license, and CLIA numbers compared. What each one is for, who issues it, and which to use where in billing and credentialing.

Medicare's Provider Transaction Access Number, how it differs from the NPI, how it is structured, and why both matter for Medicare billing.

How DEA numbers are structured, the check-digit formula, controlled substance schedules, and how to verify a prescriber's DEA registration.

How the NUCC taxonomy system classifies specialties, the 10-character code structure, the three-level hierarchy, and how to find and choose your code.

What PECOS does, the three-system chain with NPPES and I&A, how PECOS differs from NPPES, the 2026 application fee, and enrollment status verification.

Step-by-step enrollment, which CMS-855 form to use, pre-enrollment checklists by provider type, EFT setup, MAC review, site visits, and participating status.

The 5-year and 3-year revalidation cycles, how to find your due date, when to submit, what happens if you miss the deadline, and the rebuttal process.

Who must enroll via CMS-855O, the three requirements, eligible specialty types, claim denial scenarios, and the Order and Referring dataset fields.

The six enrollment steps, NPE contractor change, accreditation requirement, NPI per location, surety bond, quality standards, and the one-location rule.

Fix password resets, recover your I&A credentials, set up multi-factor authentication, and update your NPI record. Plus who to call for each problem.

Access your Medicare enrollment account step by step. The I&A System relationship, password expiration, user roles, and which help desk to contact.

Which NPI goes in which claim field, how to resolve ordering and referring denials by code, name-matching rules, and how to check PECOS before submission.

Primary source verification step by step. What NPPES and PECOS each verify, OIG and SAM exclusion screening, red flags, and the monthly monitoring cadence.

How to protect NPI and Medicare enrollment records from fraud, the five-step PECOS review routine, EFT safeguards, and what to do if compromised.

A plain-English guide for patients. What each profile section means, what PECOS enrolled tells you about your bill, and what the registry cannot show.

What CLIA requires, who must be certified, the five certificate types, the three-agency structure (CMS, CDC, FDA), proficiency testing rules, and how to look up any lab.

How FDA grants waivers, all 155 waived analytes by clinical category, the manufacturer instructions rule, off-label use risks, and when a CoW lab must upgrade.