Unlocking NPI: The Identity Layer Behind Healthcare Providers

Over the last two decades, fintech has found a new home in the healthcare industry. Providers increasingly rely on modern financing platforms, digital payment processors, and embedded lending solutions to support patient decision-making and keep their practices running smoothly. 

More than that, according to the National Library of Medicine, fintech has pioneered a “digital healthcare revolution for accessible, affordable, and effective patient-centered care”. It’s more than a business opportunity; it leads to better care practices across the industry

As a result, thousands of clinics, dental groups, surgical centers, and specialty practices now need to be onboarded, verified, and underwritten in the same way any other merchant would be in financial services.

Source: Fiat Ventures

But onboarding a healthcare provider isn’t like onboarding a retail shop or an e-commerce brand. Healthcare comes with its own identity layer, compliance rules, and regulatory benchmarks.

That identity layer is the National Provider Identifier (NPI) system.

For fintechs that serve healthcare providers, NPI data is the foundational signal that determines whether a provider can be trusted, licensed, and onboarded safely. And it plays a critical role in determining how quickly a fintech can scale within this highly regulated space.

This matters now more than ever. According to McKinsey, administrative complexity costs the U.S. healthcare system more than $370 billion annually, with provider verification and credentialing as major drivers of that cost. Reducing friction in provider onboarding is a strategic advantage, and NPI is the key to achieving it.

---

What Is NPI? The Identity Layer of U.S. Healthcare

Introduced by the Centers for Medicare & Medicaid Services (CMS) under HIPAA’s administrative simplification rules, the NPI is a 10-digit numeric ID designed to standardize how providers are identified across every healthcare transaction.

Before NPI, each insurer and payer used its own internal numbering system, leading to mismatches, billing errors, and fragmented records. NPI solved this by creating one canonical identity for every provider, nationwide.

There are two types of NPIs:

• Type 1: Individual providers — physicians, dentists, surgeons, nurses, specialists.
  
• Type 2: Organizations — group practices, clinics, surgical centers, hospitals, labs, and other medical facilities.

Once assigned, an NPI never changes, even if the provider moves, switches specialties, or transitions between organizations. Think of it as the healthcare equivalent of an EIN, except instead of just identifying a business entity, NPI also links to extensive clinical and licensing information that underwriters need to verify.

Here’s what a typical NPI record can include:

• Provider Taxonomy (Specialty Classification)
• ​​Practice and Mailing Addresses
• State License Numbers & Status
• Organizational Affiliations
• Historical Changes
• Contact Information

Why this dataset matters for underwriting

For fintechs that work with healthcare providers, the information above plays the same role that EIN and business verification play in traditional merchant underwriting.

But NPI goes further:

1. It provides industry-specific identity validation: Healthcare underwriting requires verifying both the business and the clinician behind it. NPI enables that with one lookup.

2. It reduces fraud risk: Ghost clinics, unlicensed providers, or misclassified specialties introduce significant compliance exposure. NPI data helps identify mismatches early.

3. It accelerates onboarding workflows: Instead of asking providers to manually enter specialty, address, license info, or organizational details, fintechs can auto-populate this data from a trusted national registry.

4. It standardizes healthcare merchant identity: Unlike other industries, where data sources are fragmented, healthcare has one canonical source of truth. This makes automation far more feasible.

5. It improves scoring, segmentation, and approval logic: A provider’s specialty and structure directly influence risk and revenue projections (e.g., cosmetic surgery clinics vs. general dentistry vs. dermatology). NPI taxonomy becomes a core underwriting signal.

---

Why Healthcare Fintechs Depend on NPI (and How PatientFi Uses It)

Here’s why healthcare fintechs rely on NPI data:

• Identity Verification: Confirms a provider is genuine, licensed, and active
• Assess risk: Ensures the practice matches the services being financed
• Fraud Prevention: Prevents the onboarding of ghost clinics or suspended license holders
• Faster Merchant Onboarding: Allow healthcare providers to sign up for financing or payments with minimal friction
• Compliance: HIPAA, CMS rules, and state-level licensing requirements

Case Study: How PatientFi Uses NPI

According to Bain & Company, patient financing and other healthcare payment solutions are growing more than 20% year over year, and one of the biggest barriers to scaling these models is the operational lift required to onboard and verify providers.

PatientFi is a patient-financing platform that enables healthcare providers to offer more affordable payment options for elective treatments. To onboard a new provider into its network, PatientFi has to ensure:

• The clinic or practitioner is licensed 
• Their listed specialties match the procedures they offer
• Their practice locations are legitimate
• The organizational structure is accurately represented

These checks matter because real risks surface quickly in healthcare underwriting. A lapsed or revoked license could mean that financing procedures can’t be legally performed. A mismatched specialty might signal a clinic offering services outside its scope. An invalid address often points to shell clinics designed to defraud lenders. Each item on the list protects PatientFi from onboarding providers who aren’t legitimate, compliant, or safe.

Before Worth, this required underwriters to swivel between multiple external tools and databases to gather NPI information, verify details manually, and resolve mismatches.

It worked, but not at scale.

By integrating NPI data directly into the Worth platform, PatientFi no longer needs to rely on manual searches or multiple external systems. Worth automatically:

• Retrieves the correct NPI record
• Populates specialty, address, and licensing details
• Flags inconsistencies or risk indicators
• Streamlines workflows for high-volume underwriting teams

The result: PatientFi reduced healthcare provider onboarding time by 50%.

This improvement didn’t just eliminate friction.

It accelerated revenue. 

Providers get activated faster, patients gain immediate access to financing options, and underwriting teams spend more time reviewing meaningful signals rather than gathering basic information.

With NPI data now integrated into the Worth platform, healthcare is no longer a complex, operationally heavy vertical for fintechs. Whether you serve dental groups, cosmetic surgery practices, specialty clinics, or multi-location provider networks, you can onboard them with the same speed and accuracy as any other merchant, without adding headcount or relying on fragmented tools.

---

Ready to scale your healthcare provider onboarding?

If you’re a healthcare fintech or building financial products for providers, Worth can help you:

• Verify providers instantly
• Reduce manual underwriting steps
• Prevent fraud and compliance issues
• Activate more clinics in less time

Speak with our team to see how NPI-driven onboarding and underwriting works inside Worth.