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NPDB Reporting Requirements and Query Access
| Legislation | Who Reports? | What Information is Reported? | Who is Reported? | Who May Query/ Request Information? |
|---|---|---|---|---|
| Title IV | Medical malpractice payers | Medical malpractice payments | Practitioners | Hospitals (required by law) Other health care entities with formal peer review Professional societies with formal peer review State Medical and Dental Boards and other State Licensing Boards Plaintiff's attorney/pro se plaintiffs (limited circumstances) Health care practitioners (self-query) Researchers (De-identified statistical data only) |
| State Medical and Dental Boards | Adverse licensure actions (including but not limited to network participation and panel membership) | Physicians and dentists | ||
| Hospitals Other health care entities with formal peer review |
Adverse clinical privileges actions | Physicians and dentists Other practitioners (optional) |
||
| Professional societies with formal peer review | Adverse professional society membership actions | Physicians and dentists Other practitioners (optional) |
||
| Drug Enforcement Administration | DEA controlled substance registration actions | Practitioners | ||
| HHS Office of Inspector General | Exclusions from Medicare, Medicaid and other Federal health care programs | Practitioners | ||
| Section 1921 | Peer review organizations | Negative actions or findings by peer review organizations | Practitioners | Hospitals and other health care entities* Professional societies with formal peer review* Quality Improvement Organizations* State Licensing and Certification Authorities Agencies administering Federal health care programs, including private entities administering such programs under contract Federal Licensing and Certification Agencies Health plans State law enforcement agencies*** State Medicaid Fraud Control Units*** State agencies administering or supervising the administration of state health care programs*** Federal law enforcement officials and agencies Health care practitioners, health care entities, providers, suppliers (Self-Query) Researchers (de-identified, statistical data only) |
| Private accreditation organizations | Negative actions or findings by private accreditation organizations | Health care entities, providers, suppliers | ||
| State Licensing and Certification Authorities | State licensure and certification actions | Practitioners, health care entities, providers, suppliers | ||
| State law enforcement agencies*** State Medicaid Fraud Control Units*** State agencies administering or supervising the administration of state health care programs*** |
Exclusions from a state health care program
Health care-related civil judgments in state court Health care-related state criminal convictions Other adjudicated actions or decisions |
Practitioners, providers, suppliers (all actions) | ||
| Section 1128E | Federal Government agencies Health plans |
Federal licensure and certification actions *
Exclusions from a Federal health care program** Health care-related Federal or state criminal convictions** Health care-related civil judgments in Federal or state court Other adjudicated actions or decisions |
Practitioners, providers, suppliers (all actions) |
*These entities have access to all information reported under Section 1128E and limited information under Section 1921.
**Reported by Federal Government agencies only.
***The NPDB regulations define "state law or fraud enforcement agency" to include but not to be limited to these entities.
