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Linking Providers

NPIs, PAC IDs, Enrollment IDs, CCNs, CLIAs and More

Andrew Bruce

2024-12-13

Source: vignettes/articles/linking-providers.Rmd
linking-providers.Rmd


Individual Provider 

vctrs::vec_rbind(
  display_long(providers(pac = 7810891009)) |> tibble::add_column(source = "`providers()`"),
  display_long(reassignments(pac = 7810891009)) |> tibble::add_column(source = "`reassignments()`"),
  display_long(clinicians(pac = 7810891009)) |> tibble::add_column(source = "`clinicians()`"),
  display_long(nppes(npi = 1043245657)) |> tibble::add_column(source = "`nppes()`"),
  display_long(order_refer(npi = 1043245657)) |> tibble::add_column(source = "`order_refer()`")) |> 
  distinct(name, value, .keep_all = TRUE) |> 
  gt(groupname_col = "source", 
     row_group_as_column = TRUE, process_md = TRUE) |> 
  opt_table_font(font = google_font(name = "JetBrains Mono")) |> 
  tab_options(column_labels.hidden = TRUE, 
              table.width = px(600),
              heading.background.color = "black",
              heading.align = "left", 
              stub_row_group.font.weight = "bold") |> 
  tab_header(title = md("**PROVIDER**: Mark K. Fung, M.D.")) |> 
  opt_horizontal_padding(scale = 2) |> 
  opt_all_caps()
PROVIDER: Mark K. Fung, M.D.
providers() npi 1043245657
pac 7810891009
enid I20031120000251
specialty_code 14-22
specialty_description PRACTITIONER - PATHOLOGY
state VT
first MARK
middle K
last FUNG
gender Male
reassignments() associations 1
organization UNIVERSITY OF VERMONT MEDICAL CENTER INC
pac_org 3779491071
enid_org O20060822000040
state_org VT
reassignments 98
entry Reassignment
clinicians() credential MD
school UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
grad_year 1999
specialty PATHOLOGY
facility_name UNIVERSITY OF VERMONT MEDICAL CENTER INC
members_org 1023
address_org 111 COLCHESTER AVE
city_org BURLINGTON
zip_org 054011473
phone_org 8028470000
nppes() entity_type Individual
enum_date 2006-07-11
last_update 2013-10-08
status Active
prefix Dr.
credential MD, PhD
sole_prop FALSE
purpose Practice
address 111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE - PATHOLOGY
city BURLINGTON
zip 054011473
country US
phone 802-847-3000
fax 802-847-3509
tx_code 207ZB0001X
tx_primary TRUE
tx_desc Pathology, Blood Banking & Transfusion Medicine
tx_license 042-0010655
tx_state VT
id_code 05
id_desc MEDICAID
id_state VT
id_identifier 1010070
order_refer() eligible Medicare Part B
eligible Home Health Agency
eligible Durable Medical Equipment
eligible Power Mobility Devices
eligible Hospice 


affiliations(pac = 7810891009) |> 
  pull(facility_ccn) |>
  map_dfr(~hospitals(facility_ccn = .x)) |> 
  select(-reh_conversion) |> 
  display_long(cols = !organization) |> 
  filter(!is.na(value)) |> 
  gt(groupname_col = "organization", 
     row_group_as_column = TRUE) |> 
  opt_table_font(font = google_font(name = "JetBrains Mono")) |> 
  tab_options(column_labels.hidden = TRUE, 
              table.width = px(800),
              heading.background.color = "black",
              heading.align = "left", 
              stub_row_group.font.weight = "bold") |> 
  tab_header(title = md("**FACILITY** AFFILIATIONS")) |> 
  opt_horizontal_padding(scale = 2) |> 
  opt_all_caps()
FACILITY AFFILIATIONS
UNIVERSITY OF VERMONT MEDICAL CENTER INC npi_org 1568419976
pac_org 3779491071
enid_org O20021111000009
enid_state VT
facility_ccn 470003
doing_business_as UNIVERSITY OF VERMONT MEDICAL CENTER
specialty_code 00-09
specialty PART A PROVIDER - HOSPITAL
incorp_date 1995-01-01
incorp_state VT
structure CORPORATION
address 111 COLCHESTER AVE
city BURLINGTON
state VT
zip 54011473
location_type OTHER HOSPITAL PRACTICE LOCATION: HOSPITAL - GENERAL PRACTICE AND CLINICS
registration Non-Profit
multi_npi FALSE
subgroup Acute Care
npi_org 1568419976
pac_org 3779491071
enid_org O20021111000009
enid_state VT
facility_ccn 470003
doing_business_as UNIVERSITY OF VERMONT MEDICAL CENTER
specialty_code 00-09
specialty PART A PROVIDER - HOSPITAL
incorp_date 1995-01-01
incorp_state VT
structure CORPORATION
address 111 COLCHESTER AVE
city BURLINGTON
state VT
zip 54011473
location_type OTHER HOSPITAL PRACTICE LOCATION: HOSPITAL - GENERAL PRACTICE AND CLINICS
registration Non-Profit
multi_npi FALSE
subgroup Other
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER npi_org 1033270699
pac_org 2769396878
enid_org O20120110000201
enid_state NY
facility_ccn 330250
doing_business_as THE UNIVERSITY OF VT HEALTH NETWORK - CHAMPLAIN VALLEY PHYSICIANS HOSP
specialty_code 00-09
specialty PART A PROVIDER - HOSPITAL
incorp_date 1926-01-01
incorp_state NY
structure CORPORATION
address 75 BEEKMAN ST
city PLATTSBURGH
state NY
zip 129011438
location_type MAIN/PRIMARY HOSPITAL LOCATION
registration Non-Profit
multi_npi FALSE
subgroup Acute Care


Exploring links between providers can lead to many interesting insights. For example, there is a hospital in New York named Elizabethtown Community Hospital.

providers(organization = "Elizabethtown Community Hospital") |> 
  gt_preview(top_n = 10) |> 
  opt_table_font(font = google_font(name = "JetBrains Mono"))
npi pac enid specialty_code specialty_description state organization
1 1053656744 3577554138 O20040521000534 12-70 PART B SUPPLIER - CLINIC/GROUP PRACTICE NY ELIZABETHTOWN COMMUNITY HOSPITAL
2 1891785184 3577554138 O20101110000259 00-85 PART A PROVIDER - CRITICAL ACCESS HOSPITAL NY ELIZABETHTOWN COMMUNITY HOSPITAL
3 1487923637 3577554138 O20190719002511 12-59 PART B SUPPLIER - AMBULANCE SERVICE SUPPLIER NY ELIZABETHTOWN COMMUNITY HOSPITAL
4 1407061591 3577554138 O20220827000145 00-85 PART A PROVIDER - CRITICAL ACCESS HOSPITAL NY ELIZABETHTOWN COMMUNITY HOSPITAL
5 1053656744 3577554138 O20240508002551 12-70 PART B SUPPLIER - CLINIC/GROUP PRACTICE CT ELIZABETHTOWN COMMUNITY HOSPITAL
6 1053656744 3577554138 O20240509001572 12-70 PART B SUPPLIER - CLINIC/GROUP PRACTICE FL ELIZABETHTOWN COMMUNITY HOSPITAL
7 1053656744 3577554138 O20240515002137 12-70 PART B SUPPLIER - CLINIC/GROUP PRACTICE VT ELIZABETHTOWN COMMUNITY HOSPITAL 
hospitals(organization = "Elizabethtown Community Hospital") |> 
  gt_preview(top_n = 10) |> 
  opt_table_font(font = google_font(name = "JetBrains Mono"))
npi_org pac_org enid_org enid_state facility_ccn organization specialty_code specialty incorp_date incorp_state structure address city state zip location_type registration multi_npi reh_conversion subgroup
1 1891785184 3577554138 O20101110000259 NY 331302 ELIZABETHTOWN COMMUNITY HOSPITAL 00-85 PART A PROVIDER - CRITICAL ACCESS HOSPITAL 1926-05-08 NY CORPORATION 75 PARK ST ELIZABETHTOWN NY 129322300 OTHER HOSPITAL PRACTICE LOCATION Non-Profit TRUE FALSE None
2 1407061591 3577554138 O20220827000145 NY 33Z302 ELIZABETHTOWN COMMUNITY HOSPITAL 00-85 PART A PROVIDER - CRITICAL ACCESS HOSPITAL 1926-05-08 NY CORPORATION 75 PARK ST ELIZABETHTOWN NY 129322300 OTHER HOSPITAL PRACTICE LOCATION Non-Profit FALSE FALSE None


The Hospital Enrollment API includes only Medicare Part A (hospital) providers, so we only get two rows back, but those include a new data point: two facility CCNs. Plugging those into the Facility Affiliations API, we can retrieve information on the individual providers practicing at this hospital. First, the all-numeric CCN (331302):


affiliations(facility_ccn = 331302) |> 
  gt_preview(top_n = 20) |> 
  opt_table_font(font = google_font(name = "JetBrains Mono"))
npi pac first middle last suffix facility_type facility_ccn
1 1003029125 6204824378 STACI L CARTER-KELLY NA Hospital 331302
2 1013141860 8022069558 DEBORAH M KAMPSCHROR NA Hospital 331302
3 1013910256 5890719371 JOSE M ACOSTAMADIEDO NA Hospital 331302
4 1023377843 6901115278 LINDSEY B WILHELM NA Hospital 331302
5 1043257819 0345243655 PAOLO NA FEDI NA Hospital 331302
6 1043397656 4183764558 ANTHONY F TRAMONTANO NA Hospital 331302
7 1043672140 7214229350 VANESSA NA FIORINI FURTADO NA Hospital 331302
8 1063409282 4284548819 NIDAL NA MAKHOUL NA Hospital 331302
9 1073099172 0547519381 BROOKE A MAGGY NA Hospital 331302
10 1073585055 0749217313 TODD J WHITMAN NA Hospital 331302
11 1073660684 1759418007 GAYLEN M BIGELOW NA Hospital 331302
12 1083148837 0042564882 NEIL A KRULEWITZ NA Hospital 331302
13 1083771927 7012087018 JOSEPH C MIHINDUKULASURYIA NA Hospital 331302
14 1083861934 2860555141 STEVEN J ELLIOTT NA Hospital 331302
15 1093796898 5597848077 ANDREW C MAHONEY NA Hospital 331302
16 1093905911 1759424534 ANNA NA WOJTASZEK NA Hospital 331302
17 1134186703 2567476948 JAMES S KENNEY NA Hospital 331302
18 1144215997 9638269707 RICHARD N DIMICK NA Hospital 331302
19 1144634791 1951521335 SOUZANA NA OBRETENOVA NA Hospital 331302
20 1154042729 0840667812 ISABELLE NA DUCHESNAY NA Hospital 331302
21..188
189 1992947865 9032365804 CHRISTOPHER R MASON NA Hospital 331302


That returns individual providers affiliated with the hospital. Now to search the alphanumeric CCN (33Z302):

affiliations(facility_ccn = "33Z302") |> 
  gt_preview(top_n = 10) |> 
  opt_table_font(font = google_font(name = "JetBrains Mono"))
npi pac first middle last facility_type facility_ccn parent_ccn
1 1396989059 8921259557 MARY K HALLORAN Nursing home 33Z302 331302
2 1538173869 0547299091 IL JUN CHON Nursing home 33Z302 331302
3 1801893318 3577568724 ROB L DEMURO Nursing home 33Z302 331302


That returns more affiliated individual providers that practice in the Hospital’s nursing home..


An alphanumeric CCN represents a sub-unit of the hospital, here a nursing home. We would get the same result if we’d set the parent_ccn argument to the numeric CCN, i.e. affiliations(parent_ccn = 331302)