Guide to provider search

One of the most common questions we receive at Serif is “We tried searching for ‘X’ provider in the data and no results turned up even though I know they are in-network.”

Even though it is possible a payer may have not posted every single contract in their network, usually the issue stems from the challenges in matching directly to a specific provider.

At Serif, we give you the skills, knowledge, and tools so you know how to search up providers in the transparency data and today, we’ll give you some of our tips and tricks you will need to know to figure out how to find a provider in the data. 

Table of Contents

This guide has three sections — each with various sub-sections, feel free to type the section name into 'ctrl-f' to skip to what may be relevant to you:

1. Basic concepts
   1. What is a provider?
   2. What is an NPI?
   3. What is an EIN?
2. How to find this information
   1. Searching for hospitals
   2. Searching for other providers
      1. Finding the right name
      2. Going from ‘Name’ to NPIs
      3. Going from NPIs to EINs
      4. [Optional] Going from EINs to NPIs
3. Conclusion and final takeaways

First, some basic concepts –

What is a provider?

To most people, we call providers by their name – e.g, ‘X’ hospital, ‘Y’ clinic, ‘Z’ physicians group. However, this is a very imprecise way to identify providers given:

(a) multiple clinics / hospitals can share the same name (e.g.,Saint Francis),

(b) a provider’s branded name may differ from their legal name (e.g.,Season Health is actually Surely Health Inc)

To resolve this, we have more precise ways to identify providers – namely, NPIs and EINs.

What is an NPI?

An NPI is a 10 digit identification number for a provider. You can search them up for free here in the NPPES (National Plan and Provider Enumeration System) registry: https://www.hipaaspace.com/

They look like this –

NPIs have two types:

(1) Type 1 – these are for individuals and usually have a last-name, first-name structure

(2) Type 2 – these are for groups and usually correspond to the ‘name’ you think of when recalling a provider

For finding someone in the price transparency data, their Type 2 NPI is usually what you need to look for.

What is an EIN?

An EIN (also known as TIN) is an Employer Identification Number (or, Taxable Identification Number) – think of it as a SSN for a business. 

Most payers who publish transparency data (with the notable exception of folks like Anthem who use Type 2 NPIs) display rates based on the EINs they have contracts with. Due to this, an EIN is usually the most accurate way to identify providers in the transparency data.

However, unlike NPIs, there is no website (like HIPAA space) where you can look up names easily to find EINs / TINs. This is where Serif’s provider directory data comes into play to help you out.

Second, how to find this information –

Now that we know we have better tools to identify providers than searching a name – the question is how do you find the complete set of EINs and NPIs associated with a provider?

We recommend the following process:

Searching for hospitals

Are you searching for a hospital? Then, the steps you take should look like the bullets below. Let’s say you are searching for Hammond Hospital in Illinois

• Google “Hammond Hospital Illinois Price Transparency” or “Hammond Hospital Illinois Machine Readable Files” – you should end up at this url for their price transparency page and if you click ‘price transparency tool’ you should see a ‘standard charges’ file
• Click on ‘standard charges’ and it should trigger a file to download – the first 9 digits of this file is Hammond Hospital’s EIN: 364264350
• Then, to grab the NPIs, go to https://www.hipaaspace.com/ and search “Hammond Henry Hospital” and copy-paste the relevant type-2 NPIs
• Now, you have a name, EIN, and NPIs you can use to more comprehensively search the price transparency data
• Our final recommendation here would be to see if Hammond Hospital has any other contracting EINs they did not post publicly on their website by searching which EINs are affiliated with the type 2 NPIs from HIPAA space – to perform this NPI to EIN crosswalk though, you need Serif’s Provider Search capabilities and lo and behold they do in fact have another EIN: 366008003 

Now – if that is a lot of Googling, you could also try and use our nifty provider org search tool to streamline the process here:

• Just search “Hammond Henry Hospital” inside our provider directory and if we can, we’ll try to surface the right EINs and NPIs for you

Searching for other providers

But what if you are not searching for a hospital and you need to find rates for another provider? What if searching inside Signal does not give you all the results you need for EINs, NPIs? 

Here is what we recommend:

Again, we need to populate 3 pieces of information for the provider:

(1) Correct Legal Name

(2) Type 2 NPIs

(3) EIN (*most important)

Let’s take these piece by piece, beginning with (1) Name.

(1) Finding the right ‘Name’:

This sounds counter-intuitive given if you are searching for a provider you probably already know their name but this is actually where we see the most issues occur.

Due to how providers’ legally incorporate, their official name may be distinct from what you know them as. To figure out their official name, we would recommend the following tricks:

(A.) Look at the Terms of Service / Privacy Policy pages on their website – they often contain their ‘true’ name – e.g., Season Health is actually Surely Health Inc

(B.) See if they have any affiliated practices they could use for contracting on their website –   e.g., ORA Orthopaedics actually contracts under “Quad Cities ASC” 

And, if those do not work, you may need to try something more advanced, such as:

(C.) Go to their leadership page on their website and search their executives’ names inside HIPAA space to see what group NPIs they show under – e.g., for Berry Street Nutrition, they use the type-2 NPI associated with their founding clinical director  

(D.) Go to the ‘find a provider’ or ‘find a physician’ part of their website, note the names, and see which group-NPIs and EINs they are affiliated with in Signal – e.g., if we wanted to confirm Berry Street Nutrition uses the type-2 NPI associated with their founding clinical director, we can go to “Find a Provider” and search ‘Rose’ Yun Ze in https://www.hipaaspace.com/ to find this NPI number: 1730960964 

Now if you search this NPI number inside Signal by Serif Health, you will see it links to one EIN: 462531252

And if you search this EIN in Signal by Serif Health, you will see it is the EIN associated with Berry Street’s founding clinical director, Marjorie Nolan Cohn LLC

(2) Going from ‘Name’ to NPIs:

Once you have the right name for a provider group, finding the type-2 group NPIs associated with them is pretty straightforward. 

All you have to do is search the ‘Name’ inside https://www.hipaaspace.com/ or Signal by Serif Health using the “Org” option.

(3) Going from NPIs to EINs:

Now that you have the NPIs, the final remaining piece is grabbing the right EINs for a provider. To do this, use the “NPI” option inside Signal:

Searching an NPI this way returns the related EINs:

For example, if I searched NPI #1811184971, it would give me the related-EIN (highlighted in grey) 710897031

(4) [Optional] Going from EINs to NPIs:

At this point, you should have a complete set of EINs and NPIs to query the data.

As a final check to confirm, what you can do is use the “EIN” option inside Signal to search for any related type 2 NPIs you may be missing that are relevant

For example – if we tried to find all the group NPIs associated with EIN 133757370, we’d see the following three “Laboratory Corporation of America Holdings” NPIs we’d want to bring in as well if we had not already:

Conclusion and final takeaways

Like anything involving data and healthcare, finding a provider involves nuance, research, and effort to do comprehensively and correctly. Hopefully, with these tips and tricks, you can get more out of the price transparency data!

Some final takeaways:

• Spend time and effort identifying the correct name for your provider of interest – often, the provider’s website, especially their Terms of Service / Privacy Policy pages, contain their legal entity name they use for contracting
• Once you have a name, compile the relevant group NPIs using a tool like Signal provider search or the publicly accessible NPPES registry on https://www.hipaaspace.com/
• After finding the correct NPIs, use Signal to cross-walk the NPI(s) to the relevant EIN(s) by selecting “NPI” in the provider search drop-down
• As one final step, also use Signal to cross-wak the EIN(s) to any group NPI(s) you may have missed