Data sources & methodology

The public datasets we check

• NPPES NPI Registry — provider identity, entity type, taxonomy, and registry status (queried live).
• CMS public PECOS enrollment file — the public Medicare fee-for-service enrollment signal.
• CMS Order & Referring file — ordering/referring/certifying eligibility flags.
• CMS Medicare Revalidation and Reassignment lists — revalidation due dates and exact reassignment relationships.
• CMS Medicare Opt-Out Affidavits and Revoked lists.
• CMS Doctors & Clinicians (Care Compare) national file — clinician profile data.
• CMS Care Compare Facility Affiliations file — clinician-to-facility affiliation records, joined by exact CCNs.
• OIG List of Excluded Individuals/Entities (LEIE) and state Medicaid exclusion lists — exclusion review signals.
• SAM.gov exclusions — checked when the deployment has SAM.gov API access configured; without that access, SAM.gov is outside the result's scope.

How fresh the data is

Live sources such as the NPPES NPI Registry are queried at lookup time. Snapshot sources are refreshed from CMS and OIG on their publication cadence, typically monthly, and each result names the snapshot's vintage plus the exact time it was checked, so you can always see how fresh the answer is.

When a snapshot is stale, partial, or missing, the result says so explicitly instead of serving a confident answer from doubtful data.

Exact identifiers only

Relationship and enrollment claims are joined by exact public identifiers — NPI, enrollment IDs, PAC IDs, CCNs — never by name similarity. Name-based matches, where offered, are framed as candidates for review, not as proof.

What this tool does not check

No state licensure, DEA registration, NPDB records, CMS Preclusion List coverage, or payer approval. It does not access the PECOS portal, does not adjudicate claims, and never uses beneficiary or claims data. Absence of a row in a public file is never presented as a negative finding, and exclusion-list matches are review signals to verify with the issuing agency.

Who runs this

This tool is operated by Episode Alert and serves the same verification engine on pecos.episodealert.com and npi.episodealert.com. Questions and corrections are welcome via the help option in the app.

Official sources

• NPPES NPI Registry
• CMS provider enrollment data (data.cms.gov)
• OIG LEIE exclusions