OIG Exclusion6d ago
NPI: 1942476080
| LEIE row ID | 27 |
| Type | 1128b8 |
| Exclusion date | 2017-05-18 |
| Description | DME COMPANY |
| Dataset release | 2026-05-08 |
Source: OIG LEIE Exclusions List
Fonteum · Data · NPPES NPI Registry
NPPES
Dataset confidence
CMS NPPES NPI Registry Data
Fonteum wraps the CMS National Plan and Provider Enumeration System — across — with per-field provenance, FHIR R4 US Core output, and bulk export via the HL7 $export specification. Health-tech teams and analytics platforms use this layer to build NPI-keyed data pipelines without managing the weekly full-file parse cycle themselves.
Reviewed by Jennifer Montecillo, MD, medical reviewer. Non-practicing medical reviewer.Last reviewed: June 2026 · Next review: December 2026 · Data last updated (dataLastUpdated): 2026-05-28About our reviewers →
Risk signals (live)
Deterministic anomaly detection across the NPPES dataset
Every provider record is continuously checked against 5 deterministic rules: OIG exclusion status, anomalous payment patterns, specialty mismatches between NPPES and PECOS, enrollment lapses, and claim inactivity. Each signal cites the exact source row that triggered it — no ML black box, no confidence scores without evidence.
What is NPPES?
The National Plan and Provider Enumeration System is the CMS-administered registry that issues and tracks National Provider Identifiers. Every provider and organization that bills federal health programs — physicians, nurses, chiropractors, dentists, therapists, labs, hospitals, and supplier entities — is enumerated in NPPES. The NPI is the universal key for claims processing, credentialing, clinical directory queries, and cross-source data joins across the entire federal provider data ecosystem.
The NPPES full-file download covers approximately 8 million records, with 6.8 million+ active providers at any given snapshot. Records include NPI, provider type (individual vs. organization), name, practice address, mailing address, taxonomy code and description, enumeration date, last-update date, and deactivation date where applicable. The file is published weekly on Sundays as a flat CSV; Fonteum ingests it within 48 hours. For a field-by-field breakdown of NPI structure, the check-digit algorithm, Type 1 vs. Type 2 entity encoding, and NUCC taxonomy codes, see the NPPES data-model deep-dive.
Limitations: NPPES is self-reported. Providers update their records on an honor-system basis; address and specialty data can lag real-world changes by months. Fonteum's provenance layer records these limitations per field rather than presenting NPPES data as a ground-truth authority. The methodology page documents a 6.8% known address mismatch rate against the 2025 CMS Care Compare reference set.
The FHIR R4 wrapper and provenance layer
Fonteum maps each NPPES record to the HL7 FHIR R4 US Core 6.1.0 Practitioner profile and exposes it at /api/fhir/Practitioner/{NPI}. Organizational NPIs map to the US Core Organization profile at /api/fhir/Organization/{NPI}. The CapabilityStatement at /api/fhir/metadata declares full USCDI v3 Provider conformance across five resources.
Each FHIR resource carries a 14-tuple provenance tagon meta.tag using Fonteum's coding system, encoding source family, snapshot date, methodology version, field-level confidence, and cross-reference status. This makes the provenance machine-readable without requiring consumers to call a separate API to understand where each field came from.
Bulk export: the HL7 FHIR R4 Bulk Data Access $export endpoint at /api/fhir/Practitioner/$export delivers the full 6.8M provider corpus as NDJSON, signed with SMART Backend Services OAuth 2.0. Suitable for warehouse ingestion, embedding pipelines, and large-scale analytics without per-record polling.
Who uses NPI data with provenance
Payer credentialing platforms
Primary-source credentialing for network rosters requires NPI-keyed lookups with a documented retrieval timestamp for audit purposes. Fonteum's per-field provenance satisfies the CAQH and URAC credentialing documentation requirements without custom tooling.
Patient navigation and access platforms
Finding in-network providers by specialty, accepting-new-patients status, and location requires a clean, taxonomy-normalized provider dataset. NPPES is the primary source; Fonteum adds address validation, taxonomy normalization, and real-time FHIR queries.
Healthcare analytics and data vendors
Analytics products that enrich claims data, market-size models, or referral-pattern analysis all anchor to NPI. Fonteum's bulk export with provenance metadata makes the weekly refresh a managed dependency rather than a bespoke ETL job.
Frequently asked questions
- What is NPPES and what data does it contain?
- The National Plan and Provider Enumeration System (NPPES) is the federal registry maintained by CMS that assigns National Provider Identifiers (NPIs) to every healthcare provider and organization that bills federal health programs. Each NPI record includes provider name, address, taxonomy code (specialty), enumeration date, NPI type (individual vs. organization), and NUCC credential details. Fonteum ingests the NPPES weekly full-replacement file — approximately 8 million records covering 6.8M+ active providers — and parses it into structured, query-ready form.
- How does Fonteum's NPPES layer differ from the public NPPES API (NPI Registry)?
- CMS provides a public NPI lookup API at npiregistry.cms.hhs.gov with per-record query support. It does not offer bulk export, field-level provenance, or FHIR-compatible output. Fonteum adds bulk $export over FHIR R4 Bulk Data Access, per-field fourteen-field provenance (source, source_url, dataset_id, snapshot, methodology, last_checked, confidence, availability, and six additional fields), taxonomy-code normalization against the NUCC Health Care Provider Taxonomy code set, and cross-source joins to CMS PECOS PPEF and OIG LEIE on the same NPI key.
- Does Fonteum provide NPPES data for all provider types?
- Yes. The NPPES file covers Type 1 (individual) and Type 2 (organizational) NPI holders across all 120+ NUCC taxonomy codes — physicians, nurses, dentists, chiropractors, therapists, labs, hospitals, group practices, and suppliers. Fonteum ingests the full file without specialty filtering. Taxonomy-specific subsets (dermatology, chiropractic, plastic surgery) are available as pre-filtered exports through the data-platform catalog.
- Can I use Fonteum's NPI data to build a provider directory or lookup tool?
- Yes, subject to the data-platform agreement and attribution requirements. NPPES data is published under U.S. Government Works and is freely redistributable. Fonteum's provenance layer and API infrastructure carry separate terms. For provider-directory builds at scale — including deduplication, address normalization, and taxonomy mapping — Fonteum's audit-pack export is the fastest path to a clean, structured provider dataset.
Access the NPPES data layer
The Audit Pack includes a pre-built NPPES export matched to CMS Care Compare and LEIE on NPI. For bulk FHIR access, custom taxonomy filters, or dedicated delivery schedules, contact the data engineering team.
Original analysis · Medicare provider enrollment
What the provider population looks like, on the NPI key
Fonteum's provider backbone joins the NPPES NPI registry to the CMS PECOS enrollment file on the shared NPI. In the current snapshot it holds Medicare enrollment records spanning distinct NPIs across 56 states and territories and 325 CMS provider types — 85.5% individual practitioners and 14.5% organizations. Every record carries field-level provenance back to its CMS source file and snapshot date.
2,556,656
Distinct NPIs in the provider backbone
2,548,303
Individual (Type 1) enrollments — 85.5% of records
433,496
Organizational (Type 2) enrollments — 14.5%
325
Distinct CMS provider/supplier types represented