Understanding Provider Attributes and Attribute Clusters

  • Attribute Clusters
  • Provider

Each source record you provide to Provider Data Management, and each reference identity in the Reference Database, is comprised of multiple demographic data values. These values are known as Attributes. Some attribute values are logically grouped together into Attribute Clusters. For example, the attributes of first name, middle name, and last name are grouped together into an attribute cluster known as Name.

Provider Data Management includes three categories of attributes: Core, Extended, and Custom

Core Attributes

Core attributes exist in both the Provider Data Management data model as well as the Reference Database identity data model. They have pre-defined data structures and are used in the matching process to determine whether two identities are the same or not.

The core attributes are also evaluated against a normalization and validation service to remove certain anomalies or format certain attributes more consistently – for example, an SSN number submitted to Provider Data Management with hyphens will be normalized to remove the hyphens; or an SSN number that is invalid (for example the Social Security Administration rules indicate that any SSN beginning with 9 is invalid) will be persisted in Provider Data Management but marked as invalid for matching purposes.

Core attributes table

Cluster Attribute Description Intended Provider Type
Source Name

The name/code of the source from which a specific provider record comes.

Individual or Organization

 

ID

The local unique identifier of a specific provider record within the source, also referred to as Native ID.

Person First name First name for a person Individual
Middle name Middle name for a person
Last name Last/family name for a person
Prefix Name prefix, such as Dr., Mr., or Mrs.
Suffix Suffix, e.g. Jr., Sr., etc.
Credential A person's credentials, such as MD, DO, or PhD
Organization Name Legal Business Name The legal business name or most used named for the organization. Organization
Other Name Any other name that the organization may be referred to as.
Parent Organization Name The name of the organization’s parent company.
Address Street line 1 1st line of the street address. Certain
components of the street address, such as
street type or street direction, may be
normalized to their abbreviated versions. For example, STREET would be normalized to ST, or WEST would be normalized to W.

Individual or Organization

Street line 2

2nd line of the street address. Certain components of the street address, such as unit type, may be normalized to their abbreviated versions. For example, APARTMENT would be normalized to APT.

City City for the address
State State code (2-digit) for the address. State names that are fully spelled out (e.g. KANSAS) will be normalized to the 2-character code (e.g. KS).
Postal code Zip code (5-digit or 5+4 digit) for the address.

National Provider Identifier

 

 

NPI

10-digit National Provider Identifier as assigned by the National Plan and Provider Enumeration System (NPPES).

Individual or Organization

 

Entity Type Code

This is a required field. When adding a new provider record, set field value to "1" for individual practitioner data and "2" for organization data. 

License

 

 

Number

The medical license number issued to a provider by a state.

 

Individual or Organization

 

State

The state that issued the license.

Taxonomy Code

The 10-character code that designates the classification and specialization of the license, typically per the National Uniform Claim Committee (NUCC) code set list.

Gender Gender

Gender code – M, F, U, O, T, A, and N are valid. Full gender text strings will be normalized as follows:

  • M - Male
  • F - Female
  • U - Unknown
  • O - Other
  • T - Transgender
  • A - Ambiguous

 Strings of ‘Not Applicable’, ‘NA’, or ‘N/A’ will be normalized to N.

Individual

Phone Number Number 7, 10 or 11 digit phone number with no hyphens or other punctuation Individual or Organization
Type The type of fax number, such as Reception or Billing. Freely enterable; does not need to conform to any predefined values.
Fax Number Number 7, 10 or 11 digit fax number with no hyphens or other punctuation Individual or Organization
Type The type of fax number, such as Reception or Billing. Freely enterable; does not need to conform to any predefined values.
Email Email address Email address Individual or Organization

Extended Attributes

The Extended attributes and attribute clusters in Provider Data Management that are not used in the matching algorithm are list in the table below.

Extended attributes table

Cluster Attribute Description Intended Provider Type
Medicare Info

In Pecos

A flag to represent if the provider is enrolled in the Provider, Enrollment, Chain, and Ownership System(PECOS).

Individual

Accepts Medicare

A flag to represent if the provider accepts Medicare.

Disciplinary Info

Warning

Indicator that a sanction prevents a Provider from billing Medicare.

Individual

Exclusion Type

Explanation for why a Provider was barred from billing Medicare.

Location Info

Rural/Urban/Suburban

Indicator for where a practice location exists.

Individual

Colo Code

Practice co-location code; may be used to link providers practicing at the same location; derived algorithmically from our reference data vendors.

Education

Med School

Medical school the provider received a degree from.

Individual

Grad Year

Year of medical school graduation for the provider.

Alternate Identifier



Value

The value of the identifier.

Individual or Organization

Type

The type of identifier represented by the value.

State

The state that issued the identifier or that the identifier is valid within.

Issuer

The organization that issued or assigned the identifier.

Group Taxonomy

Group Taxonomy Code

The 10-character code that designates if an Organization is a Single- or Multi-specialty group.

Organization
Authorized Official







First Name

Give name for a person known to represent an organization.

Organization

Middle Name

Middle name for the authorized official.

Last Name

Last/family name for the authorized official.

Title

Title of the authorized official.

Prefix

Name prefix, such as Dr.,Mr., or Mrs.

Suffix

Name suffix, such as Jr., or Sr.

Credential

The authorized official's credentials, such as MD, DO, or PhD.

Phone Number

7, 10 or 11 digit phone number used to contact the authorized official.

Practice Info

Estimated Practice Years

Estimated number of years the provider has been practicing.

Individual

Custom Attributes

You can define custom attributes in their instance of Provider Data Management. They do not have a pre-defined data structure. Each client must define and interpret the structure of the custom attributes based on the JSON objects they submit into Provider Data Management. Custom attributes are not subject to any normalization or validation processing. Provider Data Management software is not aware of, and does not interpret, the contents of the custom attributes.

Custom attributes are represented in the JSON object by prefixing the custom attribute name with “custom.”

For example, suppose a client wanted to use a custom attribute to capture the information about when a practice location was open for business–the days of the week and time of day when open, plus any notes.  

Within the JSON object for the identity in a postIdentity web service request, the client would insert this JSON object:

"custom.businessHours": [ 
        { 
          "days": "M - F", 
          "time": "9AM – 5PM", 
          "notes": "Saturday by appt only" 
        } 

The client has decided that is the structure they want to use to record all 'open for business' information.  Whenever that identity is retrieved, the identity object includes (along with the usual core and extended attributes) the custom attribute–it is up to the client to be aware of and interpret the custom attribute structure.

Web service interactions are available to insert, update, retrieve, and delete data from the Provider Data Management. Refer to our Web Service API documentation for more information about these services.