USE CASE · CREDENTIALING & PROVIDER-DATA ENRICHMENT
Credential against the federal record — not a stale directory.
Query supported provider identity, taxonomy, enrollment, and quality records from NPPES, PECOS, and CMS. Available source and observation metadata travels with the response; provider-wide historical replay is not universal.
providers PECOS enrollmentsSource-specific provenanceSource-specific retained history
✓ No PHI✓ Available source metadata✓ Captured dates only✓ JSON + CSV
The credentialing burden
Re-checking a directory you cannot date.
Provider directories drift the moment they are published — a taxonomy changes, an enrollment lapses, an address moves. Credentialing and re-credentialing means re-checking each field against the primary source, and a directory accuracy review cannot tell you when a field was last true. That gap is exactly what payer directory-accuracy enforcement penalizes.
Fonteum exposes supported public-record fields with available source and snapshot metadata. Missing dates remain explicit, so a re-credentialing file does not imply point-in-time support that the source or response did not supply.
The developer pain
Joining four files by hand, then losing the lineage.
NPPES, PECOS, QPP, and the exclusion lists are four different files on four refresh cadences with no shared key beyond the NPI. Stitching them yourself means a brittle ETL job — and once joined, the lineage of which source produced which field is gone.
One GET by NPI returns the supported joined fields, with available source, snapshot date, and confidence. The join, the freshness, and the provenance are the response — not something you reconstruct downstream.
How it works
The sources joined, and how a field is stamped.
NPPES
Identity & taxonomy
Legal name, NPI, primary and secondary taxonomy, practice address — re-derived from the CMS NPI Registry on its release schedule.
PECOS
Medicare enrollment
Enrollment status and reassignment, joined by NPI. The signal a credentialing team checks to confirm a provider can bill Medicare.
QPP
Quality signal
CMS MIPS final score where present — a federally reported quality measure attached to the provider, not a Fonteum opinion.
LEIE
Exclusion flag
An OIG / SAM exclusion flag rides on the same record, so a screen and an enrichment are a single call.
Integration & workflow
One record. Two ways in.
Developers fetch a provider by NPI over REST. Credentialing teams reconcile a roster and export the enriched record. Provenance and snapshot fields remain source- and response-specific.
GET /api/v1/providers/{npi}
curl https://fonteum.com/api/v1/providers/1003894328 \
-H "Accept: application/json"Response
{
"data": {
"npi": {
"value": "1003894328",
"_source": "CMS NPPES", "_snapshot": "2026-05-01"
},
"taxonomy_primary": {
"value": "207RC0000X",
"_source": "CMS NPPES", "_snapshot": "2026-05-01"
},
"enrollment_status": {
"value": "active",
"_source": "CMS PECOS", "_snapshot": "2026-05-01"
},
"mips_final_score": {
"value": 88.4,
"_source": "CMS QPP MIPS", "_snapshot": "2025-12-01"
},
"excluded": {
"value": null,
"_source": "OIG LEIE", "_snapshot": "2026-06-01"
},
"exclusion_coverage": {
"status": "coverage_stale",
"determination": "indeterminate",
"serving_as_of": "2026-05-08",
"attested_as_of": "2026-07-01"
}
},
"meta": {
"api_version": "v1",
"methodology_url": "https://fonteum.com/methodology"
}
}Fields return with the source and snapshot metadata available for that response; a missing field is reported as missing. The history endpoint can return only retained versions and may have no prior row for a subject.
- 01Submit the NPI you are credentialing, or a roster of NPIs.
- 02Inspect the source and snapshot fields supplied for identity, taxonomy, enrollment, quality, and exclusion records; fields may be null or absent.
- 03Reconcile against your internal record; fields that are stale or mismatched are flagged with their as-of date.
- 04If the response exposes a retained prior version, use its captured date; otherwise the historical view is unavailable.
- 05Export the enriched record with the response-level provenance fields that are available for the credentialing file.
Sample audit-evidence artifact
PROVIDER ENRICHMENT — CREDENTIALING RECORD
NPI ................. 1003894328
Taxonomy (primary) .. 207RC0000X [NPPES · 2026-05-01]
Medicare enrollment . active [PECOS · 2026-05-01]
MIPS final score .... 88.4 [CMS QPP · 2025-12-01]
Exclusion screen .... indeterminate [serving 2026-05-08 · attested 2026-07-01]
Coverage note ....... not a clearance; check current issuing-agency lists
Record as-of ........ current saved observation (prior version not assumed)
Methodology ......... providers/v1
The sample shows source and snapshot fields; production availability varies by response.A point-in-time view is evidence only when the relevant source and date have a retained captured version. Provider-wide replay for arbitrary past dates is not available.
Proof — not logos
Supported fields identify their public source.
Providers
Unique NPIs enumerated from the CMS NPI Registry — the identity backbone every enriched field hangs from.
PECOS enrollments
Medicare enrollment rows joined where NPI is published. The newest source date observed July 12 was June 18, 2026.
Quality scores
CMS MIPS final scores attached where reported — a federal measure, cited to its source, never a Fonteum rating.
providers/v1
Methodology version
The version documents how the record is built. A months-later reproduction also requires the retained source input; row-history coverage is not universal.
“We do not tell you a provider is good. We tell you what the federal record says, where it came from, and when.”
CREDENTIALING & ENRICHMENT
Enrich a roster against the federal record, field by field.
Questions
Before the security questionnaire.
How is this different from buying an NPPES extract?
An extract is a flat snapshot. Fonteum exposes available source and observation metadata from NPPES, PECOS, and CMS quality files. Provider-wide row history is not universally retained, so a past credentialing date can be reconstructed only when the response actually supplies a captured prior version.
Can I see what a provider record looked like on a past date?
Not universally. As-of reads work only for captured versions retained after Fonteum began tracking the relevant source. Production row history is currently concentrated in UK sanctions, with small retained sets for procurement awards, OFAC, UN sanctions, and provenance claims; a provider NPI may have no prior version.
Which fields do you enrich?
Identity and taxonomy from NPPES, Medicare enrollment status from PECOS, MIPS quality scores from CMS QPP, plus exclusion and sanction flags. Source, snapshot, and confidence fields appear where the participating source and response supply them; gaps remain null or absent.
How fresh is the data?
Publisher schedules differ from loaded observations. The July 12 audit found NPPES at June 10 and PECOS at June 18; field-level observation metadata varies by response and must not be inferred from cadence.
Do you assert that a provider is credentialed?
No. Fonteum returns supported public-record facts with the provenance fields available for that response. The credentialing decision is yours, and consequential facts should be checked at the named source.
Go deeper
The data and research behind the record.
Solutions
All solutions — by use case & buyer →
Guide
Provider credentialing data — the full guide →
Data catalog
NPPES provider registry →
Data catalog
CMS PECOS Medicare enrollment →
Data catalog
CMS MIPS score data →
Use case
Exclusion & sanctions screening →
Use case
Audit evidence & defensible programs →
For payers
Health-plan credentialing & directory accuracy →
For developers
Fonteum for developers & AI teams →
For compliance
Fonteum for compliance & risk teams →
FONTEUM · CREDENTIALING
Enrich provider data on public records only. No PHI.