Detailed Guide on NPI Lookup Tool

The NPI Lookup tool is a searchable database that allows you to look up a provider by National Provider Identifier (NPI), or by name and location. The look-up tool will return information on services and procedures provided to beneficiaries enrolled in Original Medicare (fee-for-service) for 2022.

This look-up tool is a searchable database that allows you to look up a provider by National Provider Identifier (NPI), or by name and location. The look-up tool will return information on services and procedures provided to beneficiaries enrolled in Original Medicare (fee-for-service), including use information, Medicare payment amounts, and submitted charges organized by Healthcare Common Procedure Coding System (HCPCS) code. 

The data covers calendar year 2024 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service (FFS) population (information is redacted where necessary to protect beneficiary privacy).

The database is populated from the Medicare Physician & Other Practitioners - by Provider and Service dataset and while the database has a wealth of information on payment and use for Medicare Part B services, the database has a number of limitations:

• The tool only describes care delivered to Medicare beneficiaries in the FFS program and, as a result, may not represent a provider’s entire practice. Providers may also see patients enrolled in Medicare Advantage, those with Medicaid coverage or private health insurance, or those who are uninsured.
• The tool does not provide any information on the quality of care delivered by providers.
• The information in the tool does not account for differences in the sickness of patients treated by different providers.
• Medicare pays differently when services are provided in a physician’s office versus a facility (e.g., a hospital outpatient department). For services furnished in an office setting, this tool presents the full payment. 
• However, if a service or procedure was furnished in a facility setting, in most cases, this data only includes the payment to the provider and not the payment to the facility.
• In general, when a provider administers drugs to a patient, the provider purchases the drug and Medicare pays the provider 106% of the average sales price (ASP) for the drug.
• The way CMS counts services may differ by HCPCS code. For example, if the Number of Services is 2 this may reflect two separate procedures, two 15 minute increments of a service (e.g., a 30 minute office visit), or the delivery of two units of a drug.