Provider Credentialing Search

The problem

Credentialing a provider means checking several separate sources: does the NPI exist and match the right type and specialty, is the provider actively enrolled in Medicare, and which group do they bill through? At an accountable care organization with 13,000+ providers, doing that lookup by hand, one source at a time, eats hours.

What I built

I loaded the public CMS datasets into one SQL database keyed on the NPI, so every source lines up on the same provider.

• NPPES/NPI registry: identity, provider type, taxonomy (specialty), practice locations, licenses
• Medicare PECOS enrollment data: enrollment status and group affiliations
• A custom search that filters across sources at once, e.g., specialty + location + enrollment status
• Refreshes from CMS's published files monthly / weekly — confirm

Security and data handling

Everything in the tool is public CMS data; it holds no patient information (PHI). The live demo runs read-only, and the database account it uses can only run searches, so the public site can't change or delete data.

Next steps

• Add the OIG exclusion list (LEIE) check, which flags providers banned from federal healthcare programs
• Flag stale NPPES records whose addresses or specialties no longer match enrollment data