> ## Documentation Index > Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # Step 6: NPIs, taxonomy, and CAQH > Map the Type 1 and Type 2 NPIs, taxonomy codes, locations, and credentialing profiles that Bluebird's actual payer products require. 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 ## 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. ## 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 | | Type 1 | Type 2 | | -------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | **Who** | An individual dentist | An organization provider or subpart; Bluebird's PC in this example | | **Also called** | Individual NPI | Organizational NPI, group NPI | | **Belongs to** | The person and is retained across jobs | The entity | | **Transaction role** | Commonly identifies the rendering dentist; an individual can also be the billing provider in an applicable individual/sole-proprietor enrollment | Can identify an enrolled organization as billing, pay-to, service-facility, or another permitted role; the required role and location/subpart mapping are transaction-specific | | **Identity** | Issued to the individual and retained across jobs | Issued to the organization or enumerated subpart; payer tax and enrollment associations are separate records | | **How many** | One Type 1 NPI per individual | One per entity, plus optional subparts | **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](https://npiregistry.cms.hhs.gov/) and update the existing NPPES record as required. ### Getting the Type 2 NPI The Type 2 application requires the PC's EIN. You cannot do this before Step 3 completes. 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. [nppes.cms.hhs.gov](https://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. A person with legal authority to bind the PC. Their credentials matter for later changes. 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. ### 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. ## 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: | Code | Meaning | | ------------ | ------------------------------------------------- | | `122300000X` | Dentist (classification level, no specialization) | | `1223G0001X` | Dentist, General Practice | | `1223P0221X` | Dentist, Pediatric Dentistry | | `1223X0400X` | Dentist, Orthodontics and Dentofacial Orthopedics | | `1223S0112X` | Dentist, Oral and Maxillofacial Surgery | | `1223E0200X` | Dentist, Endodontics | | `1223P0300X` | Dentist, Periodontics | 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. Use two rules when maintaining taxonomy records: 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](/reference/edi/taxonomy-codes) for the full working list and the enrollment-mismatch failure mode. ## 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. ### 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. ### 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](/guides/enrollment/set-up-edi-era-eft). ## Order of operations ```mermaid theme={null} graph LR A[PC formed] --> B[EIN issued] B --> C[Type 2 NPI] A2[Dentist licensed] --> D[Type 1 NPI
usually already exists] D --> E[CAQH profile built] C --> F[Map required entity, product,
provider and location enrollments] E --> F E --> G[Attest, then track
CAQH's displayed due date] ``` ## 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 ## 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 ## Next Payer money must land in the account of the legally authorized, payer-enrolled payee. ## Sources 1. CMS, [National Provider Identifiers](https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/unique-identifiers/npis), [NPI overview and subparts (PDF)](https://www.cms.gov/regulations-and-guidance/administrative-simplification/nationalprovidentstand/downloads/npi_overview.pdf), and [NPPES data notice](https://download.cms.gov/nppes/NPI_Files.html) (issuance does not validate licensure or credentialing); NPPES at [nppes.cms.hhs.gov](https://nppes.cms.hhs.gov/). 2. National Uniform Claim Committee, [Health Care Provider Taxonomy Code Set](https://www.nucc.org/index.php/code-sets-mainmenu-41/provider-taxonomy-mainmenu-40). Verify the code and its effective date against the current release before registration. 3. CAQH, [ProView](https://proview.caqh.org/) and [Provider User Guide (PDF)](https://www.caqh.org/sites/default/files/solutions/proview/caqh-proview-provider-user-guide-v6.pdf); Aetna Dental, [apply for participation](https://www.aetnadental.com/professionals/join-aetna-dental-network/apply-for-participation.html); Cigna, [credentialing](https://www.cigna.com/health-care-providers/credentialing). 4. MetLife, [dental provider enrollment](https://www.metlifedentalprovider.com/enrollment/); SKYGEN, [Dental Hub](https://www.skygenusa.com/dentalhub).