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, Section 1921, and
the NPDB
regulations 
.
To be eligible to query the NPDB under Title IV and Section 1921, 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 are eligible to query and receive Section 1921 reports only are:
- State health care entity licensure and certification authorities.
- State agencies administering State health care programs.
- Agencies or contractors administering Federal health care programs.
- State Medicaid Fraud Units.
- The U.S. Comptroller General.
- The U.S. Attorney General/other law enforcement officials.
- Quality Improvement Organizations.
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.
Entities that must report to the NPDB under 1921 are:
- Other State health care practitioner licensing and certification authorities.
- State health care entity licensing and certification authorities.
- Peer review organizations.
- Private accreditation organizations.
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.