Overview

Sometimes you can't find a provider in Marketscape. Many providers provide services under a different name, submit claims under a parent NPI, or just haven't updated their registry. In these cases, it is a challenge to match up a name from a sign on a building or an address from a website. This is where the NPPES NPI database comes to the rescue.

Remember that (at present) the metrics in Marketscape are generated primarily from Medicare FFS claims. If you can't find a provider, the most likely reason is that the provider has not submitted Medicare Claims. Other possible reasons that a provider is not included (or easy to find) in Marketscape:

Many facilities are part of a network, and their claims are submitted under a different NPI. See Why can't I find the hospital I'm looking for?
Many facilities in large Medical networks will be registered under the Health System name rather than under the name of the Hospital.
Often, Physicians don't update their Registry information, so their claims metrics are available in a different state. In those cases, the physician will appear in sources tables on detail pages, but if you don't have access to the state in which the physician is registered, you won't be able to view the detail page for that physician. Send an email to your CSM or support for assistance. The NPPES NPI database will help you to find that physician and confirm their state of registry.
Assisted Living Facilities, Nursing Homes, Veterans Hospitals and many others don't submit Medicare claims. The NPPES NPI database will help to identify the type of facility.
Many facilities, SNFs in particular, submit claims under a business name that is not even similar to the name on the physical sign out front of the SNF. The NPPES NPI registry helps to close the gap through an address search.

To use the NPPES NPI Database

Preliminary suggestions:

Gather as much information as you can on the provider of interest. Searching Google might help. Even a ZIP code added to the search will narrow the list to make the search results more easy to browse.

1 - Navigate to the following link: https://npiregistry.cms.hhs.gov/

The database search page looks like this:

We have added the name of a facility, the state and the NPI type for this example:

2 - Click on Search

The results of this search look like this:

Note that this identifies the NPI of the facility we desired. We could take this immediately to Marketscape and search for this facility in the global search.

3) Click on the NPI to view the details.

Here is the detail page provided for the chosen facility:

4) Evaluate what you find - what to look for

When you use any of the information you find here to search the Trella Health Solution, make sure that you have the Market (State) set to match the state found in the Primary Mailing address.

Other Name: Doing Business As - IF there is an entry in this field, this is the name we use in the Solution. If there is nothing in this field, we use the name at the top. You can search the Trella Health Solution on the Facilities page using this name.
NPI - Since this number is unique, if the provider isn't eliminated by one of the reasons mentioned above, you should be able to use this to find the provider on the appropriate page.
Enumeration date - Although this is rare, some providers are too young to be in the most recent data set. If a provider has an enumeration date within the last four to six months, it is highly likely that they will not appear until the next data release.
Primary Practice Address - This is the address we use to place a provider's data in the Solutions. Facilities don't tend to move, but physicians infrequently have an outdated primary practice from where they actually practice. This would put their metrics in a different Market (State.)
Taxonomy - This section will help you to identify the type of provider. This will help to determine whether a provider is likely to be in the Trella Health Solutions or whether the provider doesn't apply - e.g. an assisted living facility.

Lotsa Tips

Use Google to help find details about the provider that will narrow the NPPES Search.
- Often a Google Search of a physician will show their practice location
- For organizations, a Google search will frequently take you to the website for the parent health network.
Any detail you add to the search will help you to find the provider you are seeking. Add a city, state, or specialty if known
Under Provider Type - choose either "Organization" or "Individual."
Start by just searching for a name.
- For a physician, first name, last name
- For an organization, fill in that field
  - A partial name in the Organization field will give broader results, but will also be more likely to find the facility you want. For example, Saint Luke's will be a more certain way to get a result than Saint Luke's Medical Pavilion Uptown. (remember to try St and St. for Saint.)
Google Maps might also help you to identify what you are looking for. We have found the actual name for a facility by knowing the address and then looking at the sign on the building using Google Street view.