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Bluebird’s target payer products call for a Type 1 NPI for Dr. Okafor, a Type 2 NPI for its professional entity, applicable taxonomy codes, and an attested CAQH ProView profile. Do not turn that example into a universal bundle. An NPI does not establish licensure, credentialing, enrollment, contracting, network participation, or a claim effective date; CAQH adoption varies by payer and product; and the required billing, rendering, pay-to, group, subpart, and location identifiers depend on the payer and product.1

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What Bluebird did

Dr. Okafor already had a Type 1 NPI from dental school. Sam applied for Bluebird’s Type 2 NPI through NPPES after the PC’s EIN arrived. In this fictional timeline, NPPES issued it in four business days and the CAQH profile took nine days to complete because the malpractice certificate had not been issued. Those elapsed times are narrative facts about Bluebird, not processing promises.

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The two kinds of NPI

The National Provider Identifier is a 10-digit number that identifies healthcare providers in HIPAA standard transactions; dental claims included. It is issued free by CMS through the National Plan and Provider Enumeration System (NPPES). The identifier does not expire, although its NPPES record can be deactivated and must be kept current.1 A Type 1 NPI follows the dentist, not the practice. Dr. Okafor’s NPI from dental school remains hers when she joins Bluebird. Do not apply for another Type 1 merely because a dentist changes jobs; first search the NPI Registry and update the existing NPPES record as required.

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Getting the Type 2 NPI

1

Wait for the EIN

The Type 2 application requires the PC’s EIN. You cannot do this before Step 3 completes.
2

Create or use an I&A account

NPPES sign-in goes through CMS’s Identity & Access Management system. The person applying will be an authorized official of the PC, which, given officer licensure rules, is often the dentist-owner.
3

Apply at NPPES

nppes.cms.hhs.gov. Enter the PC’s exact legal name as it appears on the IRS EIN letter (CP 575), the practice location, mailing address, and taxonomy.
4

Name the authorized official

A person with legal authority to bind the PC. Their credentials matter for later changes.
5

Wait for approval

Track the NPPES submission and respond to any request for correction. Do not use Bluebird’s fictional turnaround as a closing or payer-enrollment deadline.
The legal name field is not cosmetic. Payer and program enrollment processes may validate legal-business and tax data against IRS and NPPES records. If the CP 575 says “MAYA OKAFOR DDS PC” while NPPES identifies only “Bluebird Dental,” the mismatch can delay or reject an enrollment. Use the legal name in the required field and record the brand as an authorized other name where appropriate.

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Subparts

A Type 2 organization can enumerate subparts. These components are not separate legal entities, but they may conduct their own standard transactions, hold separate certifications, operate at another address, or furnish a different type of service.1 A location is not automatically a subpart. Apply the controlling NPI subpart rules and each program’s enrollment and claim requirements. Document why a separate NPI is or is not used rather than creating one solely because another office opens.

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Taxonomy codes

A taxonomy code is a 10-character alphanumeric code identifying a provider’s type, classification, and specialization, from the Health Care Provider Taxonomy Code Set maintained by the National Uniform Claim Committee.2 It is recorded in NPPES and may be sent or evaluated in enrollment and claim transactions. NPPES taxonomy selection does not validate scope, specialty status, credentialing, or payer participation. Dentists live in the 1223 classification, with a code per recognized specialty. The working set: Dr. Okafor’s Type 1 carries the general-practice code. Bluebird’s PC, a single-specialty general practice, enrolled its Type 2 with the matching dentist taxonomy rather than a multi-specialty group code. Two rules that prevent a great deal of pain:
  1. Use the taxonomy the applicable transaction and payer record support. If a payer requires taxonomy on an enrollment or claim, the submitted value must be valid for that provider and consistent with the payer’s effective enrollment record. A mismatch is one possible cause of provider-type edits or enrollment rejections, but CARC 8 does not prove a taxonomy mismatch by itself.
  2. Organization and individual taxonomy records are distinct. The PC’s Type 2 NPI carries its own taxonomy data; each dentist’s Type 1 carries theirs. When the group adds a specialist, determine which taxonomies, provider affiliations, products, and locations each relevant payer or program requires instead of assuming that one group update covers every relationship.
See Provider taxonomy codes for the full working list and the enrollment-mismatch failure mode.

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CAQH ProView

CAQH ProView is a shared provider-data and credentialing-support database. A dentist maintains a profile and authorizes participating organizations to access it. Aetna Dental and Cigna are concrete examples of dental participation processes that use CAQH data.3 Other payers or products may use their own portal, a delegated credentialing organization, a roster, or another utility. CAQH does not itself establish a payer contract, state enrollment, network affiliation, location approval, or effective date. One concrete alternative: MetLife moved its dental credentialing onto SKYGEN’s Dental Hub in April 2025, a multi-payer dental credentialing platform.4 Follow the current instructions for the MetLife product and keep common facts consistent across NPPES, CAQH, Dental Hub, state records, and payer submissions while recognizing that each system holds different relationship data.

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Building the profile

This tutorial builds Dr. Okafor’s individual provider profile. Professional-entity contracting, billing enrollment, locations, and dentist-to-group affiliations remain separate workstreams. For the individual profile, collect:
  • Personal and demographic information
  • Dental school, postgraduate training, and board certification where held
  • Complete work history and explanations for gaps where the profile or reviewing organization requests them
  • State dental license numbers and expiration dates
  • DEA registration, where the dentist prescribes controlled substances
  • Malpractice insurance certificate of insurance, with carrier, policy number, limits, and dates
  • Hospital privileges and covering arrangements, if applicable to the provider and reviewing organization’s questions
  • Practice locations, including the PC’s address, hours, and languages spoken
  • Disclosure questions (malpractice history, license actions, criminal history)
Then upload the supporting documents, authorize the participating organizations that need access for the identified applications, and attest.
Use CAQH’s displayed due date. CAQH’s published guide assigns recurring re-attestation dates, distinguishes Illinois providers, and describes an expired status after the applicable due date.3 Treat the profile’s current status, reminder, and due date as controlling rather than hard-coding one cadence. Put that actual date on the compliance calendar.

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CAQH EnrollHub

Separate product, same organization. EnrollHub supports EFT/ERA enrollment exchanges with participating health plans. A common data submission does not mean one universal EFT or ERA approval: confirm the plans and products covered, the enrolled payee and identifiers, required validation, approval status, receiver, bank account, and effective date for each applicable relationship. See Set up EDI, ERA, and EFT.

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Order of operations

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Your artifact from this step

  • Type 2 NPI for Bluebird’s PC, matching its legal identity and recorded with the payer-specific billing and location map
  • Type 1 NPI confirmed for each dentist (existing, not newly duplicated)
  • Dental taxonomy codes selected and recorded for both
  • CAQH profile complete, documents uploaded, applicable participating organizations authorized, and attested
  • CAQH-displayed re-attestation date on the compliance calendar

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Checklist

  • Searched the NPI Registry to confirm the dentist has no duplicate Type 1
  • Type 2 NPI issued to the PC
  • NPPES legal name matches the IRS CP 575 exactly
  • Taxonomy codes chosen for both individual and group, from the 1223 dental set
  • CAQH profile complete with no unexplained work-history gaps
  • Malpractice COI uploaded
  • Target participating organizations that use CAQH authorized; alternative credentialing paths identified
  • Profile attested, with CAQH’s displayed re-attestation date calendared

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Next

Step 7: Open bank accounts

Payer money must land in the account of the legally authorized, payer-enrolled payee.

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Sources

  1. CMS, National Provider Identifiers, NPI overview and subparts (PDF), and NPPES data notice (issuance does not validate licensure or credentialing); NPPES at nppes.cms.hhs.gov.
  2. National Uniform Claim Committee, Health Care Provider Taxonomy Code Set. Verify the code and its effective date against the current release before registration.
  3. CAQH, ProView and Provider User Guide (PDF); Aetna Dental, apply for participation; Cigna, credentialing.
  4. MetLife, dental provider enrollment; SKYGEN, Dental Hub.
Last modified on August 21, 2026