Provider Directory
Datasets
Built to Plan-Net STU 1.2.0.
| Dataset | Plan-Net STU 1.2.0 target profile(s) |
|---|---|
providers | Practitioner, PractitionerRole, Location |
facilities | Organization, OrganizationAffiliation, Location |
networks | Network |
plans | InsurancePlan |
providers
One row per unique NPI, practice location, plan and specialty. A provider at two locations in two plans produces several rows.
| Column | Required | Format / values | Example |
|---|---|---|---|
npi | Yes | 10 digits | 1234567893 |
first_name | Yes | text | Jane |
last_name | Yes | text | Smith |
middle_name | No | text | G |
name_prefix | No | Mr. / Mrs. / Ms. / Dr. | Dr. |
name_suffix | No | Jr. / Sr. / II / III | Jr. |
sex | No | Male, Female | Female |
languages | Recommended | BCP 47 or English name, ;-separated. Add :level per language for Plan-Net proficiency | en;es |
specialty_nucc | Yes | NUCC taxonomy code(s), ;-separated Healthcare Provider Taxonomy | 207RI0200X |
provider_role | Recommended | physician, NP, PA, nurse, dentist PractitionerRoleVS | physician |
board_certification | If available | qualification code or name | Board Certified, Cardiology |
plan_id | Yes | key from plans; one plan per row | PLAN-DSNP |
network_id | Yes | key from networks | NET-001 |
organization_npi | If applicable | 10 digits; blank for a solo practitioner with no group NPI | 1407006835 |
accepting_new_patients | Recommended | accepting, not-accepting, existing-only, existing+family AcceptingPatientsVS | accepting |
location_name | Yes | text; Plan-Net requires a name on every location | Riverdale Family Practice |
address_line1 | Yes | text | 225 Broadway |
address_line2 | No | text | Suite 120 |
city | Yes | text | New York |
state | Yes | 2-letter USPS | NY |
zip | Yes | 5 digits, as a string; required for CMS radius search | 10007 |
county | If available | text | Bronx |
latitude | If available | decimal, WGS84 | 40.7127 |
longitude | If available | decimal, WGS84 | -74.0059 |
phone | Yes | 10 digits | 2125551212 |
location_type | Recommended | office, clinic, hospital, pharmacy, urgent-care v3-RoleCode | office |
hours_of_operation | If available | day open-close, ;-separated | mon 09:00-17:00;tue 09:00-17:00 |
facilities
One row per facility NPI, plan and network.
| Column | Required | Format / values | Example |
|---|---|---|---|
npi | Yes | 10 digits | 1407006835 |
facility_name | Yes | text | Example Hospital |
facility_type_nucc | Yes | NUCC organization taxonomy code(s), ;-separated OrgTypeVS | 282N00000X |
affiliation_type | Recommended | provider, pharmacy, lab, dme, urgent, hospice OrganizationAffiliationRoleVS | provider |
parent_org_npi | If available | 10 digits, if part of a larger system | 1234567893 |
plan_id | Yes | key from plans | PLAN-ISNP |
network_id | Yes | key from networks | NET-002 |
location_name | Recommended | text; defaults to facility_name if there is no distinct site name | Example Hospital |
address_line1 | Yes | text | 123 Park Ave |
address_line2 | No | text | Floor 3 |
city | Yes | text | Bronx |
state | Yes | 2-letter USPS | NY |
zip | Yes | 5 digits, as a string | 10463 |
county | If available | text | Bronx |
latitude | If available | decimal, WGS84 | 40.8801 |
longitude | If available | decimal, WGS84 | -73.9100 |
phone | Yes | 10 digits | 7185551212 |
networks
The authoritative list of networks, so network_id stays consistent across datasets. One row per network.
| Column | Required | Format / values | Example |
|---|---|---|---|
network_id | Yes | the exact id used in provider and facility rows | NET-001 |
network_name | Yes | text | North Region Health System |
plans
Defines each plan once, so provider and facility rows carry only plan_id. One row per plan.
| Column | Required | Format / values | Example |
|---|---|---|---|
plan_id | Yes | the exact id used in provider and facility rows | PLAN-DSNP |
plan_name | Yes | text | Example Health D-SNP |
plan_type | Yes | MA, MAPD, D-SNP, I-SNP, Medicaid, Commercial | D-SNP |
line_of_business | Recommended | code and/or label | Medicare Advantage |
plan_identifier | If MA | H#####-###-###, contract-plan-segment; blank for non-MA plans | H6776-001-000 |
contract_year | If applicable | YYYY | 2027 |
network_id | Yes | one or more keys from networks, ;-separated | NET-001;NET-002 |
owned_by_org_npi | Yes | 10 digits, the plan sponsor | 1234567893 |
administered_by_org_npi | Yes | 10 digits | 1234567893 |
These resources are served by the Provider Directory API.