provider sanction
prvdr_sanct_indDefinition
ISO-11179 Definition
An indicator identifying that a healthcare provider has been subject to a formal disciplinary action, civil monetary penalty, program exclusion, or other adverse action by CMS, the Office of Inspector General, a state licensing board, or other regulatory authority. Provider sanctions range from reprimands and fines to temporary suspension and permanent exclusion from Medicare and Medicaid participation. The OIG maintains the List of Excluded Individuals and Entities which health plans must screen against to avoid employing or contracting with sanctioned providers.
Healthcare data teams build sanction screening pipelines that query OIG LEIE, SAM.gov, and state exclusion databases on a monthly basis, flag providers with active sanctions in credentialing systems, and generate compliance reports demonstrating ongoing sanction screening for regulatory audits.
Standard Abbreviation
prvdr_sanct_ind
Category
Production DDL — DIM_PROVIDER
CREATE OR REPLACE TABLE DIM_PROVIDER (
prvdr_key INTEGER NOT NULL -- surrogate key,
prvdr_npi VARCHAR(10) -- NPI number,
prvdr_tin VARCHAR(10) -- tax ID number,
prvdr_first_nm VARCHAR(100) -- first name,
prvdr_last_nm VARCHAR(100) -- last name,
prvdr_org_nm VARCHAR(255) -- organization name,
prvdr_typ_cd VARCHAR(20) -- provider type code,
prvdr_spclty_cd VARCHAR(10) -- specialty code,
prvdr_tax VARCHAR(10) -- taxonomy code,
prvdr_state_cd CHAR(2) -- state code,
prvdr_zip_cd VARCHAR(10) -- zip code,
prvdr_ntwk_sts VARCHAR(10) -- network status,
prvdr_accpt_pt_ind CHAR(1) -- accepting patients,
prvdr_excl_ind CHAR(1) -- exclusion indicator,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical provider table. Convert to BigQuery or Databricks →
Why This Term Matters
Provider data management is one of the most operationally complex data domains in healthcare because providers move, merge, and update their credentials continuously. A data engineer who understands provider terminology can build NPI validation, credentialing, and network adequacy pipelines that keep provider directories accurate and prevent claim rejections. Stale or incorrect provider data is a leading cause of prior authorization delays and CMS compliance findings.
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