01Relates to the patient
reference data (no patient link)
Single-patient export: included in full (reference data).
02References
LICENSE_TYPE→V_MM_LICENSE_TYPE.LICENSE_TYPEMEDICAID_SPECIALTY_CODE→V_MM_SPECIALTY.MEDICAID_SPECIALTY_CODEREF_PROV_CODE→REFERRING_PROVIDERS.REF_PROV_CODEACTOR_ID→ACTORS.ACTOR_IDDEPT_CODE→DEPARTMENTS.DEPT_CODEPROVIDER_CLASS→PROVIDER_CLASSES.PROVIDER_CLASSSUPV_PROVIDER_CODE→PROVIDERS.PROVIDER_CODEOFFICE_LOCATION→LOCATIONS.OFFICE_LOCATIONTAXONOMY_CODE→TAXONOMY_CODES.TAXONOMY_CODE
03Columns
| # | Column | Type | Source type | Null | Notes |
|---|---|---|---|---|---|
| 1 | PROVIDER_CODE PK | string | varchar(20) | no | |
| 2 | LAST_NAME | string | varchar(35) | yes | |
| 3 | FIRST_NAME | string | varchar(25) | yes | |
| 4 | MI | string | char(1) | yes | |
| 5 | NAME_PREFIX | string | varchar(8) | yes | |
| 6 | NAME_SUFFIX | string | varchar(8) | yes | |
| 7 | ADDR1 | string | varchar(55) | yes | |
| 8 | ADDR2 | string | varchar(55) | yes | |
| 9 | CITY | string | varchar(30) | yes | |
| 10 | STATE | string | varchar(2) | yes | |
| 11 | ZIP | string | varchar(10) | yes | |
| 12 | COUNTRY_CODE | string | varchar(2) | yes | |
| 13 | string | varchar(254) | yes | ||
| 14 | SPECIALTY_CODE | string | varchar(3) | yes | |
| 15 | MEDICAID_SPECIALTY_CODE | string | varchar(3) | yes | |
| 16 | UPIN_ID | string | varchar(6) | yes | |
| 17 | PROVIDER_CLASS | string | varchar(15) | yes | |
| 18 | NPID | string | varchar(18) | yes | |
| 19 | DEGREE | string | varchar(40) | yes | |
| 20 | ORG_CODE | string | varchar(10) | yes | |
| 21 | LICENSE_TYPE | string | varchar(3) | yes | |
| 22 | LICENSE_NO | string | varchar(80) | yes | |
| 23 | PROV_ACTIVE | string | char(1) | yes | |
| 24 | TAXONOMY_CODE | string | varchar(10) | yes | |
| 25 | EIN | string | varchar(10) | yes | |
| 26 | DEPT_CODE | string | varchar(15) | yes | |
| 27 | SUPV_PROVIDER_CODE | string | varchar(20) | yes | |
| 28 | ACTOR_ID | string | varchar(100) | yes | |
| 29 | OFFICE_LOCATION | string | varchar(20) | yes | |
| 30 | QHP | boolean | bit | yes | |
| 31 | DIRECT_EMAIL | string | varchar(254) | yes | |
| 32 | UNLICENSED_PROV | boolean | bit | yes | |
| 33 | REF_PROV_CODE | string | varchar(20) | yes |