NPDB Query and Report
Frequently Asked Questions (FAQ)

See also:
  1. What information is in the National Practitioner Data Bank (NPDB)?

    The NPDB collects the following information:

    1. Medical malpractice payments (all health care practitioners).
    2. Adverse actions: based on reasons relating to professional competency and conduct.
      1. Licensing actions (physicians/dentists only).
      2. Clinical privilege actions (required for physicians/dentists, voluntary reporting for other health care practitioners).
      3. Professional society membership actions (required for physicians/dentists, voluntary reporting for other health care practitioners).
    3. Drug Enforcement Administration actions (all health care practitioners).
    4. Medicare/Medicaid Exclusions (all health care practitioners).

    For more information on the above actions please review the NPDB Guidebook that can be found under the Publications category on the Data Banks home page.

  2. How do I determine if my entity is eligible to query the National Practitioner Data Bank (NPDB)?

    Each entity is responsible for determining its eligibility to participate in the NPDB and must certify that eligibility in writing. Eligibility requirements for participating in the NPDB are specified in the Health Care Quality Improvement Act of 1986 (HCQIA) which defines the types of entities that are eligible to query the NPDB. The statute specifies that State licensing boards, hospitals, professional societies, and other health care entities that provide health care services and follow a formal peer review process to further quality care are eligible to query the NPDB.

    You should review the statutory definition to determine whether your entity meets these requirements. The Health Care Quality Improvement Act of 1986 is located on the Data Banks home page under the Legislation & Regulations category. Or, see page B-1 of the Eligible Entities chapter of the NPDB Guidebook, which is available under the Publications category on the Data Banks home page. (Also in Registration FAQ and Eligibility Criteria FAQ.)

  3. Why should I query the National Practitioner Data Bank (NPDB)?

    You will receive information that may be used to assist you in the decision to grant a license, medical staff privileges, or membership in your health plan. The information includes medical malpractice payments, adverse licensure, clinical privilege, professional society and Drug Enforcement Administration actions, and Medicare/Medicaid exclusions. Hospitals are required by law to query, and for others, querying is voluntary.

    Mandatory Querying: The law requires that hospitals query when a practitioner applies for permanent or temporary medical staff appointment or clinical privileges, and every two years thereafter, and when being considered for reappointment to medical staff. In addition, hospitals are required to query the NPDB when a practitioner wishes to add to or expand existing clinical privileges. Enrollment of a practitioner in the Proactive Disclosure Service Prototype (PDS) meets a hospital's mandatory querying requirement for that practitioner.

    Voluntary Querying: Hospitals may query at other times as necessary for professional review activities. Other health care entities that provide health care services and have a formal peer review process, including professional societies, may query when entering an employment or affiliation relationship with a physician, dentist (voluntary for other health care practitioners), or in conjunction with professional review activities. State licensing boards may query at any time on physicians, dentists, and other health care practitioners. Health care practitioners may self-query at any time to obtain copies of reports which may have been submitted concerning them. Plaintiff's attorneys or a plaintiff representing himself or herself (pro se) may query under certain limited circumstances.

  4. Can a plaintiff’s attorney or the plaintiff representing him or herself (pro se) query the Data Bank?

    A plaintiff’s attorney or a plaintiff representing him or herself (pro se) is permitted to obtain information from the National Practitioner Data Bank (NPDB) under limited conditions:

    • A medical malpractice action or claim must have been filed by the plaintiff against a hospital in a State or Federal court or other adjudicative body.
    • The practitioner on whom the information is requested must be named in the action or claim.
    • The plaintiff’s attorney must provide independent proof that the hospital did not make the legally required query.

    Evidence that the hospital failed to request information from the NPDB may be obtained by the plaintiff from the hospital through discovery in the litigation process. This evidence is not available to the plaintiff through the NPDB; it must be obtained from independent sources. Plaintiff’s attorney requests for NPDB information and the proof of (1) the existence of the litigation, (2) naming of the practitioner in the litigation, and (3) failure of the hospital to make the required query should be sent to Policy and Analysis, Division of Practitioner Data Banks, 5600 Fishers Lane, 8A-103, Rockville, MD 20857.

    A plaintiff’s attorney that meets the above criteria and receives NPDB information can only use the information in a legal action or claim against the hospital, not against the practitioner. Attorneys are not permitted to query the Healthcare Integrity and Protection Data Bank (HIPDB).

  5. Does the National Practitioner Data Bank (NPDB) accept reports on actions that occurred prior to September 1, 1990?

    No. As specified in the governing regulations codified at 45 CFR 60, only reports of actions taken on September 1, 1990, or later can be submitted to the NPDB.

  6. If a State Licensing board updates its files on its licensed practitioners every twelve months, are they allowed to query the National Practitioner Data Bank (NPDB) every twelve months?

    Yes, State licensing boards may query the Data Banks at any time. However, the State may find it less expensive to enroll the licensees in the Proactive Disclosure Service Prototype (PDS) for continuous monitoring rather than querying every twelve months. (Also in Querying FAQ.)

  7. What is the deadline for submitting a Medical Malpractice Payment Report (MMPR)?

    Medical malpractice payers, including self-insured entities, are required to report a payment within 30 days from the date the payment was made. However, missing the deadline does not excuse the reporter from filing a required report. The reporting entity must also send a copy of the final report to the State licensure board. (Also in Reporting FAQ.)

  8. What is the deadline for reporting National Practitioner Data Bank (NPDB) adverse licensure actions?

    State licensure boards must submit reports within 30 days from the date the adverse licensure action was taken. However, missing the deadline does not excuse the reporter from filing a required report.

  9. What is the deadline for reporting clinical privileges actions?

    Hospitals, others health care entities, and professional societies are required to report adverse clinical privilege actions that are in effect for more than 30 days. The report should be submitted within 30 days of the date that the action was taken. A Clinical Privileges action for an indefinite period becomes reportable on the 31st day the action is in effect. For example, an adverse action was taken on May 1 and it is in effect indefinitely; on June 1 the action is now in effect for more than 30 days. As a result, the action must be reported within 30 days of June 1 or, in other words, by July 1. However, missing the deadline does not excuse the reporter from filing a required report. The reporting entity must also send a copy of the final report to the State licensure board. (Also in Reporting FAQ.)

  10. Why is the Deceased Date included on the subject database form?

    The subject database is used by both reporters and queriers. The Deceased Date is a required field for report submission, so it is included within the subject database, for use by reporters. Queriers are not required to include the Deceased Date on query submissions.

  11. Does the National Practitioner Data Bank (NPDB) accept licensure reports on non-physicians and non-dentists?

    No. The NPDB accepts licensure reports only on physicians and dentists. The Healthcare Integrity and Protection Data Bank (HIPDB), however, does accept licensure reports on all licensed practitioners.

  12. A physician applying for appointment provided my entity with information about his claims history. When I compared that information to the results of our National Practitioner Data Bank (NPDB) query, I could not find the Medical Malpractice Payment Report (MMPR) from the insurance company that the physician says settled a claim on his behalf. What should I do?

    As the querying entity, you should discuss the matter with the applicant for clarification. There are five reasons why this situation might occur:

    • The query may not have contained adequate information to match an existing report.
    • If the medical malpractice payment was made prior to the opening of the NPDB in 1990, it would not have been reported in the NPDB.
    • Although the physician might have been involved in the case, if no payment was made for his benefit, no report should have been filed.
    • If the practitioner was not named in both the claim and the settlement or judgment, no report should have been filed.
    • The reporting entity failed to file a required report.

    If you conclude that there should have been a report in the NPDB, which you did not receive, please alert us to this fact by calling the Customer Service Center at 1-800-767-6732. Information Specialists are available to speak with you weekdays from 8:30 a.m. to 6:00 p.m. (5:30 p.m. on Fridays) Eastern Time. The Customer Service Center is closed on all Federal holidays.

    We want to be sure the Data Banks contain all the reports that are required by law to be reported. For additional information regarding Medical Malpractice Payment Reports (MMPR), please see page E-8 of Chapter E of the NPDB Guidebook located on the Data Banks home page under the Publications category. (Also in Querying FAQ.)

  13. My health plan made a $750,000 payment to the plaintiff to settle a lawsuit against two practitioners. The settlement was split as a $500,000 medical malpractice payment for the benefit of an internist and a $250,000 medical malpractice payment for the benefit of the cardiologist. Is my organization responsible for submitting one or two Medical Malpractice Payment Reports (MMPRs) to the National Practitioner Data Bank (NPDB)?

    Your health plan must submit two MMPRs to the NPDB because you are required to file a separate report for each practitioner when a payment is made for the benefit of, in settlement of, in satisfaction in whole or in part of, a claim or judgment against that practitioner. Each report must include the actual amount paid for the benefit of the named practitioner, as well as the total amount paid in the case, and the number of practitioners from whom it was paid. If the judgment or settlement does not specify an amount for each of the named practitioners, the reporter must allocate an amount to the named practitioners in each report as well as specify in each report the total amount paid for all practitioners and the number of practitioners for whom payment was made. If there is no other basis for allocating the total payment, the reporter may simply arbitrarily divide the total payment by the number of practitioners to determine the amount to report for each practitioner. In any event, the reporter must explain in the narrative the method used to allocate the payment. If the allocation was arbitrary, the reporter may explicitly state that the allocation was arbitrary and does not imply any determination as to the practitioner's degree of responsibility.

  14. My organization (entity), which requires that physicians be board certified, denied a physician's application for surgical privileges because the physician was not board certified in a particular clinical specialty or subspecialty. Is this action reportable to the National Practitioner Data Bank (NPDB)?

    It is not likely to be reportable. If the entity has a medical staff policy that all practitioners must be board certified to be eligible for medical staff membership, the automatic denial, of a given type of clinical privileges, is not reportable.

    However, if the committee weighs whether board certification is required on an individual basis, then a report would be required if privileges were denied to a particular practitioner because the practitioner was not board certified. (Also in Reporting FAQ.)

  15. If the practitioner is not aware of a medical malpractice payment for his/her benefit is the payment reportable?

    Yes. There is no requirement that the practitioner for whom a medical malpractice payment is made have notice of the claim, investigation, or payment. The fact that a payment was made, for the benefit of a practitioner, makes it reportable to the National Practitioner Data Bank (NPDB).

  16. Are medical residents included within the definition of a physician?

    Yes. A medical resident is included, within the definition of a physician, if the resident is licensed or otherwise legally authorized by the State to practice medicine or surgery.

    The NPDB Guidebook, located on the Data Banks home page under the Publications category, provides advice for reporting and querying on residents. See page D-1 of the Queries chapter for information on querying, and page E-1 of the Reports chapter for information on Reporting. (Also in Querying FAQ.)

  17. A physician does not know that she is under investigation for possible professional incompetence and resigns from a hospital. Is the physician's resignation reportable to the National Practitioner Data Bank (NPDB)?

    Yes. Regardless of whether the practitioner was aware that an investigation was being conducted, a practitioner's resignation or surrender of privileges must be reported if the practitioner was under investigation at the time of the resignation or surrender. The reporting entity must be able to produce evidence that an investigation was ongoing at the time of the resignation or surrender to support the report if the practitioner challenges it. In addition, resignations and surrenders must be reported in situations in which the practitioner resigns or surrenders privileges after being notified that an investigation will be conducted, but before the investigation actually begins.

  18. If a hospital reviews a surgeon's professional competence and assigns a surgical proctor for 60 days, and the surgeon cannot perform surgery without being granted approval by the surgical proctor or unless the proctor is physically present during the surgery. Is the action reportable to the National Practitioner Data Bank (NPDB)?

    Yes, since the surgeon cannot practice surgery without the approval or presence of the surgical proctor, the action constitutes a restriction on the practitioner's clinical privileges and must be reported to the NPDB.

  19. Do I report a medical malpractice payment after making a low end payment under a high-low agreement?

    Anytime there is a high-low agreement coupled with a judgment/decision of no liability on the part of the defendant and you pay the LOW end of the agreement, an NPDB report is not required. However, a payment of any amount must be reported unless there is an explicit written finding of no liability.

  20. If a dentist is dismissed from a medical malpractice lawsuit before a settlement is made for the benefit of the anesthesiologist, who also is named in the lawsuit, who would be reported to the National Practitioner Data Bank (NPDB)?

    The medical malpractice payment made for the benefit of the anesthesiologist is reportable. As long as the dentist was not dismissed from the lawsuit as a condition of settlement, in other words, the dentist was dismissed from the lawsuit independent of the settlement agreement; the dentist is not reportable to the NPDB. (Also in Reporting FAQ.)

  21. If a State medical board denies an application for license renewal because the physician did not pay his renewal fee by the deadline, is it a reportable adverse licensure action to the National Practitioner Data Bank (NPDB)?

    Generally, the denial of an application for license renewal, for failure to pay fees, is not usually considered to be related to professional competence or conduct. Therefore it would not be reported. However, if the Board has a policy which states that failure to pay renewal fees is a matter of professional conduct and non-renewal is not strictly administrative, then it would be reportable. It may be reportable to the Healthcare Integrity and Protection Data Bank (HIPDB).

Back to Top Return to FAQ Topics Customer Service Center
1-800-767-6732


Last revised June 2008