OIG Exclusion1d ago
NPI: 1922348218
| LEIE row ID | 7 |
| Type | 1128a1 |
| Exclusion date | 2018-04-19 |
| Description | OTHER BUSINESS |
| Dataset release | 2026-05-08 |
Source: OIG LEIE Exclusions List
Fonteum wraps the CMS National Plan and Provider Enumeration System — across — with per-field provenance, FHIR R4 US Core output, and bulk export via the HL7 $export specification. Health-tech teams and analytics platforms use this layer to build NPI-keyed data pipelines without managing the weekly full-file parse cycle themselves.
Every provider record is continuously checked against 5 deterministic rules: OIG exclusion status, anomalous payment patterns, specialty mismatches between NPPES and PECOS, enrollment lapses, and claim inactivity. Each signal cites the exact source row that triggered it — no ML black box, no confidence scores without evidence.
The National Plan and Provider Enumeration System is the CMS-administered registry that issues and tracks National Provider Identifiers. Every provider and organization that bills federal health programs — physicians, nurses, chiropractors, dentists, therapists, labs, hospitals, and supplier entities — is enumerated in NPPES. The NPI is the universal key for claims processing, credentialing, clinical directory queries, and cross-source data joins across the entire federal provider data ecosystem.
The NPPES full-file download covers approximately 8 million records, with 6.8 million+ active providers at any given snapshot. Records include NPI, provider type (individual vs. organization), name, practice address, mailing address, taxonomy code and description, enumeration date, last-update date, and deactivation date where applicable. The file is published weekly on Sundays as a flat CSV; Fonteum ingests it within 48 hours.
Limitations: NPPES is self-reported. Providers update their records on an honor-system basis; address and specialty data can lag real-world changes by months. Fonteum's provenance layer records these limitations per field rather than presenting NPPES data as a ground-truth authority. The methodology page documents a 6.8% known address mismatch rate against the 2025 CMS Care Compare reference set.
Fonteum maps each NPPES record to the HL7 FHIR R4 US Core 6.1.0 Practitioner profile and exposes it at /api/fhir/Practitioner/{NPI}. Organizational NPIs map to the US Core Organization profile at /api/fhir/Organization/{NPI}. The CapabilityStatement at /api/fhir/metadata declares full USCDI v3 Provider conformance across five resources.
Each FHIR resource carries a 14-tuple provenance tagon meta.tag using Fonteum's coding system, encoding source family, snapshot date, methodology version, field-level confidence, and cross-reference status. This makes the provenance machine-readable without requiring consumers to call a separate API to understand where each field came from.
Bulk export: the HL7 FHIR R4 Bulk Data Access $export endpoint at /api/fhir/Practitioner/$export delivers the full 6.8M provider corpus as NDJSON, signed with SMART Backend Services OAuth 2.0. Suitable for warehouse ingestion, embedding pipelines, and large-scale analytics without per-record polling.
Primary-source credentialing for network rosters requires NPI-keyed lookups with a documented retrieval timestamp for audit purposes. Fonteum's per-field provenance satisfies the CAQH and URAC credentialing documentation requirements without custom tooling.
Finding in-network providers by specialty, accepting-new-patients status, and location requires a clean, taxonomy-normalized provider dataset. NPPES is the primary source; Fonteum adds address validation, taxonomy normalization, and real-time FHIR queries.
Analytics products that enrich claims data, market-size models, or referral-pattern analysis all anchor to NPI. Fonteum's bulk export with provenance metadata makes the weekly refresh a managed dependency rather than a bespoke ETL job.
The Audit Pack includes a pre-built NPPES export matched to CMS Care Compare and LEIE on NPI. For bulk FHIR access, custom taxonomy filters, or dedicated delivery schedules, contact the data engineering team.