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GET
Get practitioner by NPI number
Returns information about the practitioner associated with the provided NPI number. The response includes:
  • Specialties: reported by NPPES
  • Referral scope matches: proprietary information about whether the provider is an appropriate candidate for a routine referral for a specific performable or procedure
  • Practice locations: reported by CMS National Provider Database, Doctors and Clinicians National Downloadable File, and NPPES
    • Geocoding: coordinates for the location’s address, when available
    • Stale affiliation risk: proprietary information about whether the practitioner is actually seeing patients at this location
A non-match (unlikely_match or very_unlikely_match) means a routine referral target does not fit the provider’s observed billing. It does not mean the service is outside their scope of practice or that they are unqualified; it reflects what they routinely bill, not what they are licensed or trained to do.
This endpoint serves individual practitioners (NPI-1) only.
Geocoding data is provided in part by OpenStreetMap. © OpenStreetMap contributors, available under the Open Database License (ODbL). Additional data is derived from the U.S. Census Bureau TIGER/Line® Shapefiles (public domain), from other public sources, and from proprietary sources, such as Geocodio.

Authorizations

Authorization
string
header
required

Bearer authentication header of the form Bearer <token>, where <token> is your API token.

Path Parameters

npiNumber
string
required

The 10-digit number corresponding to NPPES registration for the practitioner of interest. Must also correspond to NPI Type Individual (NPI-1) - see https://npiregistry.cms.hhs.gov/help/help-home for more information.

Required string length: 10
Pattern: ^[0-9]{10}$

Query Parameters

referralScopeMatchVersion
string

The version of the referral scope match model to use, as enumerated by GET /models. Defaults to the latest version if omitted.

staleAffiliationRiskVersion
string

The version of the stale affiliation risk model to use, as enumerated by GET /models. Defaults to the latest version if omitted.

Response

Expected response to a valid request

name
string
required

The name of the practitioner, as reported by NPPES.

nppesSpecialties
string[]
required

An array of NUCC Provider Taxonomy codes (https://www.nucc.org/index.php/code-sets-mainmenu-41/provider-taxonomy-mainmenu-40) for the practitioner, as reported by NPPES.

locations
object[]
required

An array of locations that the practitioner practices at, as reported by the CMS National Provider Database and Doctors and Clinicians National Downloadable File datasets.

servedModels
object
required

The version of each model whose output appears in this response. Always present; a key appears only when that model was served for this request, so an absent key means that model contributed nothing to the response. Use these values to record exactly which model versions a response was based on.

referralScopeMatches
object[]

One estimate per routine referral target evaluated for this practitioner. Each entry pairs a target with a label describing how well the practitioner fits it as a destination, derived from observed Medicare and Medicaid billing rather than from what their license or self-reported specialty permits. Present only when the referral scope match model was served for this request, as reported by servedModels.referralScopeMatch; empty when the model was served but produced no estimates for this practitioner.