Purchase Query Credits

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NPDB
NATIONAL PRAc1·n 10NtR DATA BANK

PURCHASE QUERY CREDITS

Privacy Policy I 0MB Number: 0906-0081 Expiration Date mm/dd/yyyy
Public Burden Statement: The NPDB is a web-based repository of reports containing information on medical
malpractice payments and certain adverse actions related to health care practitioners, providers, and
suppliers. Established by Congress in 1986, it is a workforce tool that prevents practitioners from moving
state-to-state without disclosure or discovery of previous damaging performance. The statutes and regulations
that govern and maintain NPDB operations include Title IV of Public Law 99-660, Health Care Quality
Improvement Act (HCQIA) of 1986, Section 1921 of the Social Security Act, Section 1128E of the Social
Security Act, Section 6403 of the Patient Protection andl Affordable Care Act of 2010. The NPDB regulations
implementing these laws are codified at 45 CFR Part 60. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid 0MB control
number. The 0MB control number for this information collection is 0906-0081 and it is valid until mm/dd/yyyy.
This information collection is voluntary 45 CFR Section 60.20 provides information on the confidentiality of the
NPDB. Information reported to the NPDB is considered confidential and shall not be disclosed outside of HHS,
except as specified in Sections 60.17, 60.18, and 60.21. Public reporting burden for this collection of
information is estimated to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 13N82,
Rockville, Maryland, 20857.
You do not have any query credits.
Purchase Credits

Your organization may purchase query credits as a way to pay for query transactions. The cost of
a query credit is $n.00. Once purchased, query credits will be used for payment until credits are
exhausted. Query credits are non-refundable, may be used by anyone in your organization,
and never expire.
Ready to purchase query credits?

Start My Purchase

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Entity: ENTITY AB (ASHBURN, VA) I User: adminuser1

NPDB
NA1'10NAt PIUCTITIONU 0ATA 8ANK

PURCHASE QUERY CREDITS
There are nn NPDB query credits available.

Privacy Policy I 0MB Number: 0906-0081 Expiration Date: mm/dd/yyyy
Purchase Credits

Your organization may purchase query credits as a way to pay for query transactions. The cost of
a query credit is $n.00. Once purchased, query credits will be used for payment until credits are
exhausted. Query credits are non-refundable, may be used by an yon e in your organization,
and never expire.
• 1. Select Quantity
How many credits do you want to purchase ?
$n = $n Total

I

I
I

IX

Cancel

►

2. Select Payment

►

3. Submit Your Order

Continue

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NPDB

NATIONAL PRAC1Tl'IONtR DATA BANI(

PURCHASE QUERY CREDITS
There are nn NPDB query credits available.

Privacy Policy I 0MB Number: 0906-0081 Expiration Date: mm/dd/yyyy

Purchase Credits
Your organization may purchase query credits as a way to pay for query transactions. The cost of
a query credit is $n.00. Once purchased, query credits will be used for payment until credits are
exhausted. Query credits are non-refundable, may be used by anyone in your organization, and
never expire.

I•

T

I Edit I J

1. Select Quantity
2. Select Payment

Query Credits are non-refundable and may be used at any time. Each credit is good for 1 query
transaction.
n
X $n
Sn

Query Credits
Charge per Credit

Total amount due

Available Payment Methods
0 Pre-authorized Electronic Funds Transfer (EFT}
0 Credit Card On File

Nickname
Account Number

Expires:

0 Credit Card On File

Nickname
Account Number
Expires:

REJECTION CARD
mm/yyyy
SUCCESSFUL CARD
mm/yyyy

0 Credit or Debit Card
What tvpe of credit or debit card can I use?
Account Number
Expiration Date:
Cardholders Name:

I Month
IYear

Cardholder's Billing Address:

Address Line 2:
City:

State:

I CHOOSE ONE FROM LIST

ZIP Code:

✓

Country (if U.S , leave blank):

I•

Cancel

Continue

3. Submit Your Order

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User: adminuser1

NPDB
NATIONAi, PRAC1.ITIONtR 0ATA BANK

PURCHASE QUERY CREDITS

-

Privacy Policy I 0MB Number. 0906-0081 Expiration Date: mm/dd/yyyy
Purchase Credits
Your organization may purchase query credits as a way to pay for query transactions. The cost of
a query credit is $n.00. Once purchased, query credits will be used for payment until credits are
exhausted. Query credits are non-refundable, may be used by anyone in your organization,
and never expire.
►

1. Select Quantity

►

2. Select Payment

Edit 1
1
Edit 1
1

• 3. Submit Your Order
Order Summary
Quantity
Total Payment
Payment Method

1 Query Credits

$n

Credit Card On File

By selecting Submit you will authorize this query credit purchase. Query credits are
non-refundable.
Authorized By
JACK RYAN
Title
ANALYST
Telephone
1120223675
LOW BALANCE WARNING
When my entity's query credit balance falls below I
1001 credits, all users with the ability to
purchase query credits will be notified by Secure Message.
Cancel

Submit

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State Changes
Label

PDF Name

Item Type

Trigger

OMB Number:
0906-0081
Expiration Date:
mm/dd/yyyy

Purchase
Query
Credits

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When the user selects the link the
modal is displayed with the public
burden statement content.