Information on a person who participates or is expected to participate in the care of a patient.

Data Element

Information from the submission form
Provider DEA Number
Submitted By: Robert C Dieterle / On behalf of the Da Vinci Project
Data Element Information
Use Case Description(s)
Use Case Description The collection and exchange of specific provider identifiers helps to ensure that the appropriate provider is attributed to clinical and administrative information that is collected and exchange to support coordinated patient care. In particular, the use of NPI avoids the confusion that exists with basic provider demographics where various name changes, similarity of names, and abbreviations lead to error in associating a clinical or administrative activity with the appropriate responsible provider .

In the case of DEA numbers is even more important to exchange the DEA Number with any mediation order for a controlled substance. This has become especially critical with the significant impact of Opioid addiction on a broad segment of the population.
Estimated number of stakeholders capturing, accessing using or exchanging Level 2 – all licensed providers in the NPPES data base (>1,000,000) and all providers that can prescribe controlled substances (>85,000). It impacts all hospitals (>7,000), payers (>1,800), Pharmacies (>88,000), Laboratories (>260,000) and patients (> 350 Million)
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) NPPES assigns a unique number to each registered provider
DEA assigns a number to each requesting and qualified healthcare professional.
Additional Specifications NPI information is currently defined in both the C-CDA 2.1 and in the US Core Profiles 3.1.1 for FHIR R 4.0.1. The representation of Provider NPI in FHIR is in the Practitioner resource in the Practitioner.identifier element. A separate occurrence of the same element can be used to exchange the DEA number.
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts The NPI is required in any transaction between a provider and payer for payment or authorization. NPI is usually included in C-CDAs to indicate the provider responsible for specific observations or actions. NPI is required to order any medication and for most healthcare services or devices. DEA number is always required to order controlled substances.
Number of organizations/individuals with which this data element has been electronically exchanged 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts HL7 US Core 3.1.1 Profile on Practitioner
NCPDP Script Standard – exchanged for all medication orders and orders for controlled substances
ASC X12N transactions for claims and prior authorization among others
Level 2 – these elements are exchange millions of times a day as part of both clinical and administrative transactions
Numerous summaries of exchanges are available to support the volume of transaction including volume summaries from CAQH, CMS, ONC, AMA, WEDI, NCPDP, and Direct Trust, just to mention a few.

Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) May be restrictions on the exchange of DEA numbers
Privacy and Security Concerns Since the NPI and DEA number are specific to the provider and are associated with specific clinical transactions, there may be provider sensitivity to their exchange
Estimate of Overall Burden Little or no impact – this data is already captured in EHRs and Payer Systems and should be available for inclusion in the appropriate exchanges.
Other Implementation Challenges None at this time

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