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

Data Element
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.
Estimate the breadth of applicability of the use case(s) for this data element 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.
Extent of exchange 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
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment This data element represents a specialization or a subset of the USCDI v4 data element Care Team Member(s) Identifier.

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