Entity Eligibility

Eligibility requirements for participating in the NPDB and HIPDB are specified in the legislation for each Data Bank. If your entity is not eligible to report or query under a given statute, you may not query or report to that Data Bank. Each entity is responsible for determining its eligibility to participate in the NPDB, the HIPDB, or both, and must certify that eligibility in writing.

National Practitioner Data Bank - Title IV

Entities entitled to participate in the NPDB are defined in the provisions of Title IV and the NPDB regulations.

To be eligible to query the NPDB, an entity must be one of the following:

A Board of Medical Examiners or other State licensing board.
Hospitals—must query.
A professional society that follows a formal peer review process for the purpose of furthering quality health care.
A health care entity (other than a hospital or professional society) that provides health care services and follows a formal peer review process for the purpose of furthering quality health care.

Entities that must report to the NPDB under Title IV are:

An entity that makes a medical malpractice payment.
A Board of Medical Examiners or other State licensing board.
A health care entity that takes an adverse clinical privileging action as a result of professional review.
A professional society that takes an adverse membership action as a result of professional review.

Healthcare Integrity and Protection Data Bank - Section 1128E

Entities entitled to participate in the HIPDB are defined in Section 1128E and the HIPDB regulations. Entities that must report to and that are eligible to query the HIPDB are:

A Federal or State government agency.
A health plan.

For more information on entity eligibility, see the Fact Sheet on Entity Eligibility, the NPDB Guidebook, and the HIPDB Guidebook.

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