Definition
Credentialing is the review a health plan or hospital does before a provider joins its network or medical staff. It usually checks the license, the NPI, malpractice history, and Medicare enrollment. This site can show the public NPI and a public enrollment row. It does not credential anyone. The NPI lookup is at /npi-lookup.
An NPI proves enumeration, not that a license is current and not that a plan has approved the provider. OIG exclusion and Medicare opt-out are separate public files.
Source: CMS Medicare provider enrollment description, PECOS, and the NPPES public file dated October 12, 2026.
Questions
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