Dr. Smith Left Three Years Ago. Or Did He?
A few years ago, a dentist left a Medicaid-heavy practice in Texas to open his own office.
He did everything right—or so he thought.
He gave notice.
Finished his cases.
Said goodbye to patients.
Started credentialing with his new practice.
Life moved on.
Then one day someone asked a simple question:
“Why is your name still showing up there?”
The dentist laughed.
“It isn’t.”
Except it was.
His name still appeared in provider directories.
His NPI was still associated with locations where he no longer practiced.
Some payer records had never been updated.
And suddenly a routine conversation turned into a compliance project.
Now before anyone starts assuming fraud or misconduct, let’s be clear:
Most of these situations happen because nobody followed up—not because somebody was trying to do something wrong.
But that’s exactly why they’re dangerous.
The Most Expensive Words in Compliance
In my line of work, I’ve heard a lot of explanations.
But one phrase shows up more than almost any other:
“I thought somebody else handled it.”
The office manager.
The credentialing company.
The DSO.
The HR department.
The consultant.
The departing associate assumes someone else submitted the paperwork.
The organization assumes someone else submitted the paperwork.
And sometimes nobody submits the paperwork.
Years later, the dentist discovers they never completely left.
Your NPI Is Like Your Dental License
You wouldn’t leave your dental license sitting in somebody else’s desk drawer and assume everything would be fine.
Your NPI deserves the same attention.
Federal rules require providers to maintain accurate information in NPPES. If your practice location, contact information, mailing address, or other required enrollment information changes, updates generally must be reported within 30 days.
Yet many dentists haven’t looked at their NPI profile since dental school.
Think about that for a moment.
You may have changed jobs three times, moved twice, joined a DSO, left a DSO, started a practice, sold a practice, or expanded to multiple locations.
But your NPI record may still be living in the past.
Why This Matters More Than Ever for Texas Dentists
Texas has experienced tremendous growth in corporate dentistry, Medicaid participation, and multi-location practices.
Despite the multitude of dental regulations (shocking, right?) Texas is a great place to practice dentistry, grow a business and raise a family.
As dentists move between associateships, DSOs, group practices, and private practice ownership, credentialing records become increasingly complicated.
That’s where problems start.
Particularly for dentists who have participated in Medicaid, there can be multiple layers of enrollment, provider affiliations, managed care organizations, and payer relationships that need updating.
When those relationships aren’t properly terminated, inaccurate provider records can remain active long after a dentist has moved on.
And that’s not just an administrative issue.
It’s a compliance issue.
Here’s the Question Nobody Wants to Ask
Could your former employer still be using your credentials?
Notice I didn’t ask whether they’re doing anything improper.
That’s not the point.
The point is whether your name is still connected to systems where it shouldn’t be and it’s up to you to fix it.
Ask yourself:
• Are you still listed as a rendering provider?
• Are you still listed in provider directories?
• Are you still affiliated with old practice locations?
• Are you still connected to Medicaid enrollment records?
• Does your former employer still appear on your NPI profile?
• Does your NPI still appear on payer rosters?
If you don’t know the answers, it’s time to find out.
Because auditors, investigators, and payers tend to ask questions after a problem appears.
The Toothcop prefers asking those questions before a problem appears.
The Medicaid Problem Most Dentists Never Think About
Here’s something else worth considering.
When a provider leaves a Medicaid-focused practice but remains associated with that practice in enrollment records, the consequences may extend beyond that individual dentist.
Provider directories become inaccurate.
Network records become inaccurate.
Payer data becomes inaccurate.
And administrative confusion follows.
Healthcare systems work best when provider information reflects reality.
They also get in trouble when THEIR systems are not up to date.
That starts with every dentist taking responsibility for their own professional identity.
The Toothcop’s Five-Minute Credentialing Audit
If you’ve changed jobs in the last ten years, do this today:
Step 1
Log into NPPES and review your NPI information.
Step 2
Review Texas Medicaid enrollment records and group affiliations.
Step 3
Search payer directories where you’ve previously been credentialed.
Step 4
Google your name and see what practice locations appear.
Step 5
Save documentation showing any corrections you request.
Trust me.
Future-you will appreciate having those records.
The Toothcop’s Take
Most compliance disasters don’t start with bad people.
They start with assumptions.
Someone assumed the paperwork was submitted.
Someone assumed the enrollment was terminated.
Someone assumed the credentialing company handled it.
Someone assumed everything was fine.
Then one day they discovered their name was still attached to something they left years ago.
If you’re an associate dentist, a practice owner, or a former DSO provider, take ownership of your credentials.
Your dental license is yours.
Your NPI is yours.
Your Medicaid enrollment is yours.
Your reputation is yours.
And when your name is attached to the credential, your name is attached to the risk.
— Duane Tinker, The Toothcop®