HHS Publishes a Federal Register Notice on Requirements for the National Plan and Provider Enumeration System (NPPES) Data Changes
Date Posted: Wednesday, August 20, 2025
The Department of Health and Human Services (HHS) is sending this announcement to inform interested parties of the Federal Register notice, displayed on July 30, 2025, and published on July 31, 2025, in the Federal Register. This notice provides information on changes to data elements collected by the National Plan and Provider Enumeration System (NPPES) when a provider applies for a National Provider Identifier (NPI). This change impacts public-facing data available in NPPES downloadable files and the query-only database on the internet.
Background/Context
This notice announces updates to the name, description, and values for the data element “provider gender code” in accordance with the Presidential memorandum of January 20, 2025, titled EO 14168, “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.”
On January 23, 2004, HHS published a final rule (69 FR 3434) that adopted the NPI as the standard unique health identifier for healthcare providers (hereinafter referred to as the NPI final rule). The NPI final rule established that HIPAA-covered entities must use NPIs to identify healthcare providers in electronic transactions for which the Secretary has adopted a standard. Covered entities include health plans, healthcare clearinghouses, and healthcare providers who transmit any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard.
The NPI final rule identified that NPIs are assigned to providers through the National Provider System (NPS). The preamble to the NPI final rule includes an “NPS Data Elements Table” (69 FR 3455) that lists the data elements expected to be collected about a healthcare provider and included in the NPS. The NPS is now contained within NPPES.
The NPPES assigns NPIs by identifying healthcare providers through an application process and creating a record for each one. The records are updated when healthcare providers furnish updates to the NPPES.
On March 4, 2024, HHS issued a federal register notice (89 FR 15581) clarifying the requirements expanding data elements for gender information that aligned with Executive Order 14075, “Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals” (87 FR 37189) (hereinafter, Executive Order 14075).
Executive Order 14075 was rescinded on January 20, 2025, by Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” (90 FR 8615) (referred to as "Defending Women EO"). The “Defending Women EO” directed HHS to provide to the U.S. Government, external partners, and the public clear guidance expanding on the sex-based definitions it set forth. HHS's guidance recited the definition of sex provided in the Defending Women EO as a person's immutable biological classification as either male or female, stating there are only two sexes because there are only two types of gametes. This policy affects a change in position from what HHS articulated in the March 2024 notice.
What This Notice Does
This notice announces the revision of the name of the data element “provider gender code” to “provider sex code” and announces that the code description is revised by replacing the word “gender” with “sex.” Additionally, the selection of sex code options is now limited to “M” and “F.” These changes align with HHS efforts consistent with the policy described in the Defending Women EO, which sets forth the Federal Government's prospective approach to male/female classifications.
NPPES will also disseminate the sex code options of “M” and “F” to promote improved accuracy in publicly available data. Provider gender code selections made after March 4, 2024, that are no longer available in accordance with the Defending Women EO, will now appear as blank (will have no value selected) in public-facing files.
You can find this Federal Register notice here: https://www.federalregister.gov/documents/2025/07/31/2025-14478/national-plan-and-provider-enumeration-system-nppes-data-changes
Source: CMS
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