Can Your Practice Query the NPDB? Eligibility and Alternatives

The National Practitioner Data Bank holds reports about individual practitioners in three categories: medical malpractice payments, adverse actions on a license or clinical privileges, and health-care-related judgments and convictions.

It has held them in one place since May 2013, when the NPDB and the Healthcare Integrity and Protection Data Bank (HIPDB) merged into a single Data Bank — so a query or self-query today returns what both used to hold.

The NPDB tells you how to weigh the result itself: its information should be used with other sources, and it should not be the sole source of verification of professional credentials.

A report is one input into a credentialing file, not the file.

It is also a check you cannot simply order the way you order a background check.

Querying is not available to the general public, and an organization has to register and be authorized before it can query anyone — which is why the eligibility question fills the rest of this page.

The NPDB sits inside the wider hiring process covered by our behavioral health hiring hub; the full sequence of checks, and the order to run them in, is the hiring screen — that guide owns license verification, exclusion checks and background checks, so this page stays on the NPDB itself.

Start with who cannot.

The NPDB says querying for report information is not available to the general public, and it names exactly two exceptions: practitioners querying about themselves, and limited queries by plaintiff's attorneys.

Neither is an employer option.

Everyone else has to be an authorized organization.

You register with the NPDB and are authorized to query, and it is the law — not the NPDB's discretion — that determines which organizations may query and what information they receive.

The categories that decide it for a private practice come from 45 CFR 60.3's definition of a health care entity.

Health plans and other listed entities are on the law's list too, but the branches that matter for a behavioral health employer are these:

• Hospitals. Hospitals must query the NPDB when a practitioner is granted privileges and again every 2 years, and hospitals and their human resources and recruiting departments may query on all types of health care practitioners — not only physicians — for employment decisions.
• Health care entities that run professional review. An entity that provides health care services and engages in professional review activity through a formal peer review process qualifies, or a committee of that entity — and the regulation expressly adds an HMO and any group or prepaid medical or dental practice meeting those criteria to the definition.
• Professional societies that engage in the same kind of formal peer review activity.

If your organization qualifies as a health care entity, the employment purpose is expressly covered: under 45 CFR 60.18, malpractice-payment and privileging information is available to a health care entity that has entered — or may be entering — an employment or affiliation relationship with a practitioner.

A qualifying group practice can therefore query on a therapist, psychologist or behavior analyst it is about to hire or contract with.

Access also comes with strings.

NPDB information is confidential: anyone who receives it, directly or from another party, may use it solely for the purpose for which it was provided (45 CFR 60.20(a)).

A breach is a civil money penalty matter — up to $11,000 per violation under 45 CFR 60.20(b), inflation-adjusted to a 2025 maximum of $28,619 per violation in 45 CFR 102.3.

Practically, that means a query result lives in your hiring or credentialing file for that decision, not in a shared drive or a reference call about a former employee.

The regulation defines the term precisely.

A formal peer review process means professional review conducted through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing (45 CFR 60.3).

The review activity itself has to be aimed at furthering quality health care.

Read that against how a small practice actually works.

A weekly clinical huddle, a supervisor's chart review or an informal conversation after a difficult session is review of a kind — but unless it runs through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing, it is not the professional review the definition describes.

If that is all your practice has, it does not meet the definition, and the NPDB's query service is not available to it.

This is a structural test, not a quality judgment: eligibility turns on whether the process exists in writing and in use, not on how reputable the practice is.

What meeting the test takes is an organizational artifact: professional review actually conducted through written procedures the practice has formally adopted — its own rules, not a habit — and those procedures providing for adequate notice and an opportunity for a hearing, with the review activity aimed at furthering quality health care.

The regulation expressly names group and prepaid medical or dental practices among the entities that can meet the test (45 CFR 60.3), so the structure — not the setting — is what decides it.

If you believe your practice meets the definition, registration is where that gets tested: an organization must register with the NPDB and be authorized to query before it can query anyone, so state your basis there and let the NPDB's process rule on it — and run your reading past an attorney where the stakes justify it.

One question the sources for this page do not resolve is whether peer review activity tied to an accreditation program, rather than to your own adopted procedures, satisfies the definition.

Confirm that with the NPDB at registration rather than assuming it either way.

For a practice that fails the eligibility test — and for eligible ones that want the candidate's own copy — the workable route is the self-query.

Any health care practitioner may query the NPDB about themselves at any time, and the response reports the practitioner's own information under the same categories: malpractice payments, adverse licensure or privileges actions, judgments and convictions.

The mechanics sit on the practitioner's side.

They create an NPDB personal account at no cost and can see their matching reports free of charge; a certified Self-Query response PDF requires a $3.00 annual subscription, and mailed paper copies are an additional $13.00 each (as of October 6, 2026).

The NPDB does not email self-query responses and does not send them to third parties — the response belongs to the practitioner, who may share it with whomever they choose.

So the request has to come from you: make a current self-query part of the credentialing packet for clinical hires, the way you already ask for license numbers.

Two handling details.

If you want a sealed copy, tell the candidate to forward the NPDB's paper response without opening the envelope — that is how the NPDB says a request from an organization or employer should be handled.

And keep the report's limits straight: licensing, credentialing and insuring entities may require a self-query as a condition of participation, but a copy of a self-query does not satisfy a hospital's legal duty to query the NPDB itself.

If yours is an organization that must query, the candidate's copy is a courtesy, not compliance.

For practices that do qualify, the question is usually not whether to query once but how to stay current.

The NPDB's answer has been two services: a One-Time Query, which returns a single response, and Continuous Query, which enrolls a practitioner for a year of ongoing coverage.

Pricing is the same either way: as of October 7, 2026, one One-Time Query response or one year of Continuous Query enrollment costs an eligible entity $2.50 per practitioner.

The NPDB is funded by user fees rather than appropriations.

One date to calendar: on December 4, 2026, the NPDB will merge the two services into a single product called NPDB Query, and existing Continuous Query enrollments transfer automatically.

For an eligible practice the practical upshot is simple — enroll a clinician and the enrollment carries over — but re-check the NPDB's fee page after the merge before budgeting on the $2.50 figure, which is the price as of this writing.

Take the NPDB's own advice as the standard: its information should be used with other sources and not as the sole source of verification of professional credentials.

For a practice that cannot query, the substitute stack is the one you already run — with three pieces worth naming precisely.

Exclusion screening runs on a different database, and OIG has said which one.

For exclusion screening of current and potential employees and contractors, OIG recommends the LEIE — not the NPDB — as the primary database.

The full routine, including SAM.gov and the state Medicaid lists, is our guide to monthly exclusion screening.

License verification stays at the board.

An adverse licensure action can surface in NPDB reports, but your primary check is the issuing board's own lookup — our guide to how to look up and verify a therapist's license in any state collects the state-by-state board searches.

Prescriber hires carry their own file.

For a psychiatrist or PMHNP, the credential set goes beyond any single data bank — state license, DEA registration, board certification — and our guide to verifying prescribers steps through each check.

Put together: if you are an eligible health care entity, register, query when you hire, consider Continuous Query, and treat every result as confidential, single-purpose information.

If you are not, the candidate's self-query plus the standard screens gets you most of the way — and none of those screens requires NPDB eligibility.