NPI Punctuation

PECOS and NPPES allow for the entry of punctuation and certain special characters in the provider’s Legal Business Name (LBN). Examples of acceptable punctuation and special characters are ampersands, apostrophes, commas, hyphens, left and right parentheses, periods, pound signs, and quotation marks.

When punctuation or special characters are part of a provider’s LBN as shown on the IRS CP-575, the punctuation or special characters should also appear in the LBN in NPPES and the LBN in PECOS. However, the contractor may use its discretion with respect to accepting a match between NPPES and PECOS if a comma or a period is the only discrepancy between the LBN in NPPES and the LBN in PECOS. The contractor should not delay processing a provider’s Medicare enrollment application by requiring the provider to change its LBN in NPPES in order to conform to a discrepancy related to punctuation and/or special character.

Examples of LBN Matches and Non-Matches and Actions to Be Taken

7 There may be exceptions for emergency or very unusual situations.

NPPES LBN	PECOS LBN	Exact Match
Health Systems, Inc	HEALTH SYSTEMS, INC.	Yes, this is an exact match.
Quality Care, Incorporated	Quality Care, Inc.	No, this is not an exact match (because of the abbreviation ‘Inc.’ in the PECOS LBN). In this case, the contractor may accept the match since both versions are an accurate match (e.g., Incorporated or Inc; Limited Liability Company or LLC; etc.)
Health & Rehabilitation, Inc.	Health and Rehabilitation Inc.	No, this is not an exact match (because the ampersand and ‘and’ do not match). In this case, the contractor shall refer to the IRS CP-575. If the ampersand is displayed on the IRS CP-575, the Medicare contractor may accept the match. If the ampersand is not present and the word ‘and’ is present, the Medicare contractor shall ask the provider to correct its NPPES information. The provider must change its LBN in NPPES to read in accordance with the IRS CP-575.
Allergy & Asthma, Inc.	Allergy & Asthma, INC.	Yes, this is an exact match. Upper and lower cases do not affect a match.
Foot-Ankle, LLC	Foot Ankle LLC	No, this is not an exact match (because the hyphen is in one LBN but not in the other). In this case, the contractor shall refer to the IRS CP-575. If the hyphen is displayed on the IRS CP-575, the contractor may accept the match. If the hyphen is not present, the contractor shall ask the provider to correct its NPPES information. The provider must change its LBN in NPPES to read in accordance with the IRS CP-575.
Rehab and Health, Inc.	Rehabilitation and Health, Inc.	No, this is not an exact match (because ‘Rehab’ and ‘Rehabilitation are different words). In this case, the contractor should refer to the IRS CP-575. If the LBN ‘Rehab and Health, Inc.’ is displayed on the IRS CP-575, the contractor may accept the match. If ‘Rehabilitation and Health, Inc.’ is present, the contractor should ask the provider to correct its NPPES information. The provider must change its LBN in NPPES to read in accordance with the IRS CP-575.

Many enrolled providers may actually be subparts of other enrolled providers, and some of those subparts entered their “doing business as name” as their LBN when applying for their NPIs. Once a contractor determines for certain that this situation exists, the contractor shall ask the provider to correct its NPPES information. The provider can (1) change its LBN in NPPES to read in accordance with the IRS CP-575, and (2) report its “doing business as” name in NPPES as an “Other Name” and indicate the type of other name as a “doing business as” name.