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National Registry of Health Care Providers

Source: R/nppes.R
nppes.Rd

Search the National Plan and Provider Enumeration System (NPPES) NPI Registry, a free directory of all active NPI records.

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*"

Usage

nppes(
  npi = NULL,
  entity = NULL,
  specialty = NULL,
  ind_type = NULL,
  first = NULL,
  use_alias = NULL,
  last = NULL,
  org_name = NULL,
  add_type = NULL,
  city = NULL,
  state = NULL,
  zip = NULL,
  country = NULL
)

wildcard(x)

Arguments

npi

<int> National Provider Identifier

entity

<chr> Entity type; 1 (Individual) or 2 (Organization)

specialty

<chr> Provider's specialty

ind_type

<chr> Type of individual first/last refers to: AO (Authorized Official) or Provider (Individual Provider).

first, last

<chr> WC Individual provider's name

use_alias

<lgl> Use first name alias

org_name

<chr> WC Organization's name

add_type

<enum> Address type

city

<chr> City; For military addresses, search "APO"/"FPO".

state

<chr> State abbreviation. If the only input, one other parameter besides entity or country is required.

zip

<chr> WC 5-9 digit zip code, no hyphen.

country

<chr> Country abbreviation. Can be the only input if it is not "US".

x

<chr> input

Value

A tibble

A <wildcard> object

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.

References

Examples

# nppes(npi = 1528060837)
wildcard("Jo")
#> [1] "Jo*"
#> attr(,"class")
#> [1] "wildcard"