Core Provider Entities
Provider
Represents an individual or organization:
- Provider Identifier
- Provider Name
- Provider Type
Credential
Tracks qualifications:
- License Type
- License State
- Effective Date
Provider Location
Physical practice sites:
- Address
- Taxonomy
- Service Area
Network Participation
Defines payer relationships:
- Network Name
- Participation Status
- Effective Dates
Common Modeling Errors
- Storing credentials as free text
- Losing provider history
- Mixing provider and location data
Regulatory Requirements
- CMS enrollment rules
- State licensing boards
- Network adequacy reporting
Final Thoughts
Provider data changes frequently. Logical models ensure accuracy, compliance, and operational stability.
Related Terms
- Provider
- Credential
- Network
- Taxonomy
mdatool Team
Data modeling experts helping enterprises build better databases and data architectures.
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