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National Registry of Health Care Providers

Source: R/nppes.R
nppes.Rd

nppes() allows the user to search the National Plan and Provider Enumeration System (NPPES) NPI Registry, a free directory of all active NPI records.

Usage

nppes(
  npi = NULL,
  entype = NULL,
  first = NULL,
  last = NULL,
  organization = NULL,
  name_type = NULL,
  taxonomy_desc = NULL,
  city = NULL,
  state = NULL,
  zip = NULL,
  country = NULL,
  limit = 1200L,
  skip = 0L,
  unnest = TRUE,
  tidy = TRUE,
  na.rm = TRUE,
  ...
)

Arguments

npi

<chr> Unique 10-digit National Provider Identifier number issued by CMS to US healthcare providers through NPPES.

entype

<chr> Entity type; one of either I for Individual (NPI-1) or O for Organizational (NPI-2)

first, last

<chr> WC Individual provider's first and/or last name

organization

<chr> WC Organizational provider's name. Many types of names (LBN, DBA, Former LBN, Other Name) may match. As such, the results might contain a name different from the one entered.

name_type

<chr> Type of individual the first and last name parameters refer to; one of either AO for Authorized Officials or Provider for Individual Providers.

taxonomy_desc

<chr> Provider's taxonomy description, e.g. Pharmacist, Pediatrics

city

<chr> City name. For military addresses, search for either APO or FPO.

state

<chr> 2-character state abbreviation. If it is the only input, one other parameter besides entype and country is required.

zip

<chr> WC 5- to 9-digit zip code, without a hyphen.

country

<chr> 2-character country abbreviation. Can be the only input, as long as it is not US.

limit

<int> Maximum number of results to return; default is 1200L

skip

<int> Number of results to skip after those initially returned by the API; default is 0L

unnest

<lgl> Unnest list columns; default is TRUE

tidy

<lgl> Tidy output; default is TRUE

na.rm

<lgl> Remove empty rows and columns; default is TRUE

...

Empty dots

Value

A tibble containing the search results.

National Provider Identifier (NPI)

Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. Once CMS supplies an NPI, they publish the parts of the NPI record that have public relevance, including the provider’s name, taxonomy and practice address.

Entity/Enumeration Type

Two categories of health care providers exist for NPI enumeration purposes:

Type 1: Individual providers may get an NPI as Entity Type 1.

Sole Proprietorship A sole proprietor is one who does not conduct business as a corporation and, thus, is not an incorporated individual.

An incorporated individual is an individual provider who forms and conducts business under a corporation. This provider may have a Type 1 NPI while the corporation has its own Type 2 NPI.

A solo practitioner is not necessarily a sole proprietor, and vice versa. The following factors do not affect whether a sole proprietor is a Type 1 entity: + Multiple office locations + Having employees + Having an EIN

Type 2: Organizational providers are eligible for Entity Type 2 NPIs.

Organizational or Group providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.

Some organization health care providers are made up of parts that work somewhat independently from their parent organization. These parts may offer different types of health care or offer health care in separate physical locations. These parts and their physical locations aren't themselves legal entities but are part of the organization health care provider (which is a legal entity). The NPI Final Rule refers to the parts and locations as sub-parts. An organization health care provider can get its sub-parts their own NPIs. If a sub-part conducts any HIPAA standard transactions on its own (separately from its parent), it must get its own NPI. Sub-part determination makes sure that entities within a covered organization are uniquely identified in HIPAA standard transactions they conduct with Medicare and other covered entities. For example, a hospital offers acute care, laboratory, pharmacy, and rehabilitation services. Each of these sub-parts may need its own NPI because each sends its own standard transactions to one or more health plans. Sub-part delegation doesn't affect Entity Type 1 health care providers. As individuals, these health care providers can't choose sub-parts and are not sub-parts.

Authorized Official
An appointed official (e.g., chief executive officer, chief financial officer, general partner, chairman of the board, or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization's status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.

Trailing Wildcard Entries

Arguments that allow trailing wildcard entries are denoted in the parameter description with WC. Wildcard entries require at least two characters to be entered, e.g. "jo*"

Update Frequency

Weekly

Examples

if (FALSE) { # interactive()
nppes(npi = 1528060837)

nppes(city   = "CARROLLTON",
      state  = "GA",
      zip    = 301173889,
      entype = "I")
}