NPI Registry Lookup with OIG Exclusion Check (NPPES + LEIE)

NPI Registry Lookup searches the official CMS NPPES NPI registry by NPI number, provider name, organization, specialty, city or state and returns one clean row per provider: NPI, type, name, credential, status, primary taxonomy, license, practice address, phone and registry dates. With checkExclusions on (the default), each row is also checked against the HHS OIG LEIE exclusion list and flagged excluded true or false. It uses public data only: the CMS NPI registry API and the OIG LEIE download.

Input

Set any of npi, firstName, lastName, organizationName, taxonomyDescription, city, state. This example finds cardiology practices in Houston and checks them against the exclusion list:

{
  "taxonomyDescription": "Cardiology",
  "city": "Houston",
  "state": "TX",
  "enumerationType": "",
  "maxResults": 50,
  "checkExclusions": true
}

• npi: exact 10-digit NPI. If set, other search fields are ignored.
• firstName, lastName: individual providers; a trailing * wildcard is allowed after 2 characters.
• organizationName: clinics, hospitals and groups.
• taxonomyDescription: for example Dentist, Cardiology, Nurse Practitioner.
• city, state: practice location; state is a two-letter code.
• enumerationType: NPI-1 individuals, NPI-2 organizations, or blank for both.
• maxResults: rows to return (default 50; the registry caps one search at 1,200).
• checkExclusions: download the OIG LEIE file and flag matches by NPI or by name and state.

Output

One row per provider. Real example row for an organization:

{
  "npi": "1881018208",
  "enumeration_type": "NPI-2",
  "name": "MAYO CLINIC",
  "credential": null,
  "status": "A",
  "primary_taxonomy": "Clinic/Center, Multi-Specialty",
  "license_number": null,
  "license_state": null,
  "practice_address": "200 1ST ST SW",
  "practice_city": "ROCHESTER",
  "practice_state": "MN",
  "practice_zip": "559050001",
  "phone": "507-284-2511",
  "enumeration_date": "2014-02-05",
  "last_updated": "2021-04-12",
  "excluded": false,
  "exclusion_match_type": null,
  "exclusion_type": null,
  "exclusion_date": null,
  "reinstatement_date": null,
  "url": "https://npiregistry.cms.hhs.gov/provider-view/1881018208"
}

When a provider matches the exclusion list, excluded is true and exclusion_match_type is NPI or NAME_AND_STATE, with exclusion_type, exclusion_date and reinstatement_date filled in.

Use cases

Search phrases this actor is built for:

• "NPI number lookup": pass npi, or search by name and state to find a provider's NPI.
• "Search NPI registry by specialty and city": set taxonomyDescription, city and state to build a provider list.
• "NPI provider OIG exclusion check": leave checkExclusions on to screen a clinician or organization before hiring or billing.

Typical users are credentialing teams, healthcare staffing and billing companies and compliance officers. For bulk screening of names or NPIs against OIG plus OFAC, see the exclusion-debarment-screener actor by the same publisher.

Pricing

Pay per result: each provider row returned is one billable result, listed at $0.002 per row ($2 per 1,000). Set a maximum charge on the run for a hard ceiling.

Limits

• The NPI registry caps one search at 1,200 results; narrow the search to go further.
• A NAME_AND_STATE exclusion match is a lead to verify on the OIG site, not a definitive finding; an NPI match is stronger. This is not legal or compliance advice.
• The registry is queried live. The LEIE file is downloaded on every run when checkExclusions is on.

FAQ

Where does the data come from? The CMS NPPES API (npiregistry.cms.hhs.gov) and the HHS OIG LEIE downloadable file (oig.hhs.gov).

Is a name-based exclusion match definitive? No. Verify it on the OIG site.

Can I search organizations? Yes. Use organizationName or set enumerationType to NPI-2.