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provider zip code

prvdr_zip_cd
provider·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The five-digit postal ZIP code of a healthcare provider primary practice location address, used in network adequacy analysis, geographic access to care measurement, and provider directory maintenance. Provider ZIP code is the foundational geographic unit for measuring member-to-provider travel distance and time in CMS and state regulatory network adequacy standards. Medicare Advantage plans must demonstrate that members can access primary care, specialists, and hospitals within defined distance and time standards for each ZIP code in the service area.

Healthcare data teams use prvdr_zip_cd in network adequacy models to calculate straight-line and drive-time distances between member and provider ZIP codes, identify geographic access gaps, and produce CMS-required network adequacy filings demonstrating compliance with time and distance standards.

Standard Abbreviation

prvdr_zip_cd

Category

provider

Production DDL — DIM_PROVIDER

DIM_PROVIDER.sql
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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