Individual Provider Network Data: 2019 Quarter 1

health.data.ny.gov | Last Updated 6 Sep 2019

The Individual Provider Network Data displays information on individuals participating in health plan networks from January through March, 2019. Plan network data is collected from Medicaid, Commercial, and Exchange plans on a quarterly basis by the Department of Health, including managed care plans, as well as PPO/EPO plans. For more information, please visit: https://pndslookup.health.ny.gov.

Tags: facilities and services, pnds, provider network, provider, individual

This dataset has the following 84 columns:

Column NameAPI Column NameData TypeDescriptionSample Values
Last NamestdlastnametextStandardized last name of provider
First NamestdfirstnametextStandardized first name of provider
National Provider IdentifiernpitextThe National Provider Identifier (NPI) is a 10-digit identification number issued to health care providers
Site NamesitenametextStandardized name of the office or facility building
Room or SuitermnumbertextRoom or suite number of the provider’s office
Street Addressaddress1_stdtextStandardized street address of the site
Town/Citycity_stdtextStandardized name of the town or city
Statestate_stdtextStandardized state name
CountytruecountynametextCounty Name
Borough/County CodetruecountyfipstextFederal Information Processing Standard (FIPS) county or borough code, based on geolocation
Zip Codezip_stdtextStandardized zip code
LatitudelatitudenumberSystem-generated latitude for reported address
LongitudelongitudenumberSystem-generated longitude for reported address
Wheel Chair AccessibilitywheelchrnumberWhether the office is wheelchair accessible 0=No 1=Yes
Primary designationprimdesgnumberPrimary designation of a provider. Refer to codes in the PNDS data dictionary: https://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf
Provider TypeprovtypenumberDegree or licensure of the provider. Refer to codes in the PNDS data dictionary: https://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf
Primary SpecialtyprimspecnumberPrimary specialty of the provider. Refer to codes in the PNDS data dictionary: https://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf
Secondary SpecialtysecdspecnumberSecondary specialty of the provider. Refer to codes in the PNDS data dictionary: https://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf
Board Status - Primary SpecialtybrdstatnumberLevel of education/training completed by a provider towards a recognized medical specialty certificate for the provider’s primary specialty. Refer to codes in the PNDS data dictionary: https://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf
Board Status - Secondary Specialtybrdstat2numberLevel of education/training completed by a provider towards a recognized medical specialty certificate for the provider’s secondary specialty. Refer to codes in the PNDS data dictionary: https://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf
Provider’s Gendergendernumber1=Male 2=Female
Commercial Provider Indicatorcommindnumber0=No 1=Yes
Medicaid Provider Indicatormcaidindnumber0=No 1=Yes
CHP IndicatorchpindnumberChild Health Plus (CHP) Indicator 0=No 1=Yes
HARP IndicatorharpindnumberHealth and Recovery Plan Indicator (HARP) 0=No 1=Yes
Medicaid Advantage Indicatormaindnumber0=No 1=Yes
Partial CAPS IndicatorpcapindnumberPartial Capitated (CAPS) Indicator 0=No 1=Yes
MAP IndicatormapindnumberMedicaid Advantage Plus (MAP) Indicator 0=No 1=Yes
PACE IndicatorpaceindnumberPrograms of All-Inclusive Care for the Elderly (PACE) Indicator 0=No 1=Yes
FIDA IndicatorfidaindnumberFully-Integrated Dual Advantage (FIDA) Indicator 0=No 1=Yes
FIDA IDD IndicatorfidaiddindnumberFully-Integrated Dual Advantage for Individuals with Intellectual and Developmental Disabilities (FIDAIDD) Indicator 0=No 1=Yes
HIV SNP IndicatorhivsnpindnumberHIV (Human Immunodeficiency Virus) Special Needs Plans Indicator 0=No 1=Yes
NYSOH Standard Essential Health Plan (EP) Indicator/Basic Health Program IndicatorbhpindnumberNew York State of Health Standard Essential Health Plan (EP) Indicator/Basic Health Program Indicator 0=No 1=Yes
NYSOH EP Plus Adult Vision/Dental Indicator/Basic Health Program Adult IndicatorbhpaindnumberNew York State of Health (NYSOH) Standard Essential Health Plan (EP) Indicator/Basic Health Program Indicator 0=No 1=Yes
Commercial Non-MCO Medical IndicatornonmcomedindnumberCommercial Non-Managed Care Organization (MCO) Medical Indicator 0=No 1=Yes
Commercial Non-MCO Vision IndicatornonmcovisindnumberCommercial Non-Managed Care Organization (MCO) Vision Indicator 0=No 1=Yes
Commercial Non-MCO Dental IndicatornonmcodentindnumberCommercial Non-Managed Care Organization (MCO) Dental Indicator 0=No 1=Yes
Hospital Affiliation Operating Certificate (OPCERT) #1hospcerttextOperating certificate (OPCERT) number of hospitals affiliated with the provider (1-3)
HA PFI #1pficert1textPermanent Facility Identifier (PFI) corresponding to HAOPECRT (1-3)
Hospital Affiliation Operating Certificate (OPCERT) #2hspcert2textOperating certificate (OPCERT) number of hospitals affiliated with the provider (1-3)
HA PFI #2pficert2numberPermanent Facility Identifier (PFI) corresponding to HAOPECRT (1-3)
Hospital Affiliation Operating Certificate (OPCERT) #3hspcert3textOperating certificate (OPCERT) number of hospitals affiliated with the provider (1-3)
HA PFI #3pficert3textPermanent Facility Identifier (PFI) corresponding to HAOPECRT (1-3)
Provider Location Facility Operating NumberprovcerttextOperating certificate (OPCERT) number of the provider’s location
PFIprovpfitextThe Permanent Facility Identifier (PFI) of the provider’s location
Language 1lang1textLanguage that a provider or clinical staff member can speak to a member (1-7)
Language 2lang2textLanguage that a provider or clinical staff member can speak to a member (1-7)
Language 3lang3textLanguage that a provider or clinical staff member can speak to a member (1-7)
Language 4lang4textLanguage that a provider or clinical staff member can speak to a member (1-7)
Language 5lang5textLanguage that a provider or clinical staff member can speak to a member (1-7)
Language 6lang6textLanguage that a provider or clinical staff member can speak to a member (1-7)
Language 7lang7textLanguage that a provider or clinical staff member can speak to a member (1-7)
NYSOH Individual Network 1 Indicatorhx_indv_med_ind_1numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 2 Indicatorhx_indv_med_ind_2numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 3 Indicatorhx_indv_med_ind_3numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 4 Indicatorhx_indv_med_ind_4numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 5 Indicatorhx_indv_med_ind_5numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 6 Indicatorhx_indv_med_ind_6numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 7 Indicatorhx_indv_med_ind_7numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 8 Indicatorhx_indv_med_ind_8numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 9 Indicatorhx_indv_med_ind_9numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Network 10 Indicatorhx_indv_med_ind_10numberNew York State of Health (NYSOH) Individual Network Indicator (1-10) 0=No 1=Yes
NYSOH Individual Dental Network 1 Indicatorhx_indv_dent_ind_1numberNew York State of Health (NYSOH) Individual Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH Individual Dental Network 2 Indicatorhx_indv_dent_ind_2numberNew York State of Health (NYSOH) Individual Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH Individual Dental Network 3 Indicatorhx_indv_dent_ind_3numberNew York State of Health (NYSOH) Individual Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH Individual Dental Network 4 Indicatorhx_indv_dent_ind_4numberNew York State of Health (NYSOH) Individual Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH SHOP Network 1 Indicatorhx_shp_med_ind_1numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 2 Indicatorhx_shp_med_ind_2numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 3 Indicatorhx_shp_med_ind_3numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 4 Indicatorhx_shp_med_ind_4numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 5 Indicatorhx_shp_med_ind_5numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 6 Indicatorhx_shp_med_ind_6numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 7 Indicatorhx_shp_med_ind_7numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 8 Indicatorhx_shp_med_ind_8numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 9 Indicatorhx_shp_med_ind_9numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Network 10 Indicatorhx_shp_med_ind_10numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Network 1 Indicator (1-10) 0=No 1=Yes
NYSOH SHOP Dental Network 1 Indicatorhx_shp_dent_ind_1numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH SHOP Dental Network 2 Indicatorhx_shp_dent_ind_2numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH SHOP Dental Network 3 Indicatorhx_shp_dent_ind_3numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Dental Network Indicator (1-4) 0=No 1=Yes
NYSOH SHOP Dental Network 4 Indicatorhx_shp_dent_ind_4numberNew York State of Health (NYSOH) Small Business Marketplace (SHOP) Dental Network Indicator (1-4) 0=No 1=Yes
Site NPIsitenpinumberProvider facility’s National Provider Identifier (NPI)
Plan NameplannametextName of submitted health plan
PNDSIDpndsidnumberProvider Network Data System (PNDS) identification number associated with plan submitter
Quarter/YearquartertextQuarter and year of data submission