Getting Provider Details

Many FHIR resources reference providers, called “practitioners” in FHIR. The Practitioner resources in any given record may contain demographic information (such as name and address) when provided by a source system, but this data may be missing or inaccurate. When possible, HIEBus links individual providers to entries in the NPPES Registry. The Provider Directory API enables access to these additional details when available.

Querying Practitioner Resources

Numerous FHIR resources contain a Practitioner reference. To retrieve data from the source system about these providers, you may either:

• Use a FHIR _include (e.g. GET https://[YOUR_FHIR_ENDPOINT]/Encounter?_include=Encounter:practitioner) to include provider information in the original resource request.
• Execute a separate query (e.g., GET https://[YOUR_FHIR_ENDPOINT]/Practitioner/[PRACTITIONER_ID]).

Both of these queries will return what information the source system has provided about the provider. Since this information may be incomplete or inaccurate, you may wish to supplement it by requesting information from the Provider Directory.

Provider Identifiers

A Practitioner resource will often contain several kinds of provider identifiers:

• PRACTITIONER_ID is the identifier for the provider record in the source system.
• NPI is the NPI provided by the source system.
• PROVIDER_DIRECTORY_ID is the identifier that you can use to query for additional information from the Provider Directory.
• Other identifiers, such as tax id, may also be present.

The PRACTITIONER_ID can be found in the resource id field.

Other identifiers will appear in the identifier field. The identifier type and system distinguish between the different kinds of identifiers.

For example, the various identifiers are highlighted in the Practitioner resource below:

{
    "fullUrl": "YOUR_FHIR_ENDPOINT/Practitioner/ab1d7d08-9eb7-e911-80dc-f8f21e213b22",
    "resource": {
        "resourceType": "Practitioner",
        "id": "ab1d7d08-9eb7-e911-80dc-f8f21e213b22",  <<<<<<<  This is the PRACTITIONER_ID.
        ...
        "identifier": [
            {
                "use": "usual",
                "system": "YOUR_CAREEVOLUTION_URL/identifiers/CareEvolution/CaregiverIdentifier",
                "value": "1316155500"
            },
            {
                "type": {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                            "code": "npi"
                        }
                    ]
                },
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "1316155500"           <<<<<<<  This is the NPI.
            },
            {
                "type": {
                    "coding": [
                        {
                            "system": "http://careevolution.com/fhir/IdentifierType",
                            "code": "providerid"
                        }
                    ]
                },
                "system": "YOUR_CAREEVOLUTION_URL/providerid",
                "value": "1601032"              <<<<<<<  This is the PROVIDER_DIRECTORY_ID.
            },
            {
                "system": "YOUR_CAREEVOLUTION_URL/identifiers/ACMP/TAXID",
                "value": "161582336"
            },
        ],
        ...
}

Provider Directory API

The Provider Directory API enables you to look up information about the provider from the NPPES Registry. The directory uses a separate endpoint, independent from other FHIR queries. The directory endpoint supports a limited selection of resources and search parameters focused around querying provider information.

You can use the Provider Directory to look up supplemental information about Practitioner resources, or as a stand-alone repository for finding providers.

See the Provider Directory API Reference for details.