NPI and PECOS Resources
Plain-language guides on National Provider Identifiers, NPPES, and Medicare enrollment through PECOS. Written for providers, billing teams, credentialing specialists, and developers working with health care provider data.
All articles draw from official CMS documentation. NPI data is updated weekly from the NPPES public data release. PECOS enrollment data is also refreshed weekly.
National Provider Identifier (NPI)
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.
25 answered questions covering NPI basics, entity types, how to apply and update, deactivation, prescribing requirements, and how NPI Profile data works.
Medicare Enrollment (PECOS)
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.
How to protect NPI and Medicare enrollment records from fraud, the five-step PECOS review routine, EFT safeguards, and what to do if compromised.
23 answered questions covering PECOS basics, enrollment process, changes, revalidation, telehealth, opt-out, and who to contact for help.
NPI data last updated June 07, 2026 • PECOS data last updated June 04, 2026
