Provider Network Credentialing Data
Health plan compliance teams need to screen providers against three federal sources — CMS NPPES (6.8M+ active providers), the OIG LEIE (68,055+ excluded individuals and entities, refreshed monthly), and CMS PECOS — every credentialing cycle. Fonteum makes those sources accessible with field-level federal provenance on every record, so your credentialing data is auditable back to the original government file rather than a vendor's derived list.
Three federal sources. One provenance graph.
- 6.8M+ active providers
CMS NPPES
NPI identity backbone
6.8M+ active providers (~8M total records) — provider taxonomy code, practice address, entity type, enumeration date. Distributed as a weekly full-replacement file. The authoritative federal identifier for individual practitioners and organizations.
- 68,055+ exclusions
OIG LEIE
Federal exclusion flag
OIG HHS List of Excluded Individuals and Entities — 68,055+ excluded providers, monthly federal refresh. Exclusion type, effective date, and federal citation on every record.
- Active enrollment status
CMS PECOS
Medicare enrollment status
CMS PECOS Physician and Practitioner Enrollment File — Medicare enrollment indicator, provider type, reassignment data. Cross-referenced with the NPPES NPI for a complete enrollment picture across 6.8M+ active providers and one of 17+ federal source families in the Fonteum graph.
Auditable to the federal source — not a vendor's derived list
CMS expects primary-source screening
The CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and the Provider Directory Accuracy requirements expect health plans to maintain directory data sourced from NPPES and PECOS. Fonteum makes those exact federal files accessible across 6.8M+ active providers with per-field provenance — the credentialing record traces to the CMS dataset, not to a vendor's derived product. NPPES is ingested as a weekly full-replacement file, so the screening surface tracks the current federal record.
OIG exclusion screening, monthly cadence
CMS requires Medicare Advantage organizations and Medicaid plans to screen providers against the OIG LEIE monthly. Fonteum's LEIE ingest runs on the same monthly cadence as the OIG's publication schedule from oig.hhs.gov/exclusions/, covering 68,055+ excluded individuals and entities. Every exclusion record includes the OIG HHS source citation, the download date, and the Fonteum methodology version — so the screening audit trail is complete and the exact file version checked is provable.
FHIR R4 for automated workflow integration
Fonteum's FHIR R4 US Core 6.1.0 implementation exposes provider credentialing data as Practitioner, PractitionerRole, Organization, Location, and HealthcareService resources. SMART Backend Services auth supports system-to-system integration with credentialing workflow platforms. The CapabilityStatement at /api/fhir/metadata declares full USCDI v3 Provider conformance.
From federal portal to auditable credentialing record
Ingest
Fonteum pulls directly from the federal portals on each source's native cadence — CMS NPPES as a weekly full-replacement file (6.8M+ active providers), the OIG HHS LEIE monthly from oig.hhs.gov/exclusions/ (68,055+ exclusions), and CMS PECOS enrollment on its publication schedule. No intermediary aggregator sits between the credentialing record and the government file, so a screen reflects the current federal source rather than a stale vendor snapshot.
Provenance
Every field is written with its source name, last-checked date, and documented limitation through the provider_field_provenance layer. The result is an auditable chain from each rendered fact — an NPI status, an enrollment indicator, an exclusion flag — back to the exact CMS or OIG file and date it came from. That per-field chain of custody is the evidence a CMS program-integrity review or an internal compliance audit expects.
Deliver
Screening data is available free as public research at /research and /sanctions, through the FHIR R4 US Core 6.1.0 API with SMART Backend Services auth for automated workflows, and via HL7 bulk $export for re-credentialing an entire network in one NDJSON job. Scoped pilot exports — a combined NPPES, LEIE, and PECOS file keyed to your network's NPIs — start at $2,500/mo with the field-level provenance intact.
Common questions
- What provider data does Fonteum provide for payer credentialing?
- Fonteum provides three federal data layers relevant to payer credentialing, drawn from a graph of 17+ federal source families. The first is CMS NPPES — National Provider Identifier, taxonomy code, practice address, entity type, and enumeration date for 6.8M+ active providers, distributed by CMS as a weekly full-replacement file. The second is the OIG HHS LEIE — 68,055+ excluded individuals and entities, refreshed monthly from oig.hhs.gov/exclusions/, with exclusion type and effective date on every record. The third is CMS PECOS — the Physician and Practitioner Enrollment File covering Medicare enrollment indicator, provider type, and reassignment data, cross-referenced against the NPPES NPI. Every field carries its source name, last-checked date, and documented limitations through the provider_field_provenance layer, so each credentialing record is auditable back to the original government file rather than to a vendor's derived list. That field-level chain is what turns a screening result into a defensible compliance artifact.
- How often is the OIG LEIE exclusion data refreshed?
- Fonteum ingests the OIG HHS List of Excluded Individuals and Entities monthly CSV on the same cadence the OIG itself publishes it — once per month from oig.hhs.gov/exclusions/. The current file carries 68,055+ excluded individuals and entities, and the download date plus the Fonteum methodology version are surfaced on every exclusion record. This cadence is not incidental: CMS requires Medicare Advantage organizations and Medicaid managed-care plans to screen their providers against the LEIE on a monthly basis, because payment to or employment of an excluded individual can trigger Civil Monetary Penalties under the Social Security Act. Because Fonteum mirrors the OIG's monthly publication schedule and timestamps each refresh, a compliance team can demonstrate not only the screening result but the exact federal file version and date it was checked against — the auditable evidence an enforcement review or internal audit will ask for.
- Does Fonteum's data meet CMS requirements for provider directory accuracy?
- Fonteum's data is sourced from the same federal files CMS uses to define provider directory accuracy standards — NPPES, PECOS, and CMS Care Compare. The CMS Interoperability and Patient Access Final Rule (CMS-9115-F) requires Medicare Advantage, Medicaid, CHIP, and Qualified Health Plan issuers to make accurate, machine-readable provider directory data available, and to keep it current against these primary sources. Fonteum makes those exact federal datasets accessible with per-field provenance — source name, last-checked date, and limitation attached to every value — so a plan can show its directory entries trace to the CMS dataset rather than to a commercially assembled product. Fonteum is a source-provenanced data layer, not itself a certified provider directory, network-adequacy engine, or credentialing-decision platform; it supplies the auditable federal inputs those systems consume. Coverage spans 6.8M+ active providers, and the same data is published openly at /research for independent inspection.
- Can I access Fonteum provider data via API for automated credentialing workflows?
- Yes. Fonteum implements HL7 FHIR R4 against US Core 6.1.0, exposing 5 distinct USCDI v3 Provider resources: Practitioner (NPI and taxonomy), PractitionerRole (Medicare enrollment and specialty), Organization, Location, and HealthcareService. The endpoint supports SMART Backend Services authorization for unattended system-to-system integration, so a credentialing platform can pull provider records without a human in the loop. The CapabilityStatement enumerating all five resources and their supported interactions lives at /api/fhir/metadata. For population-scale loads, Fonteum also supports HL7 FHIR Bulk Data Access via the $export operation, returning NDJSON suitable for re-credentialing an entire network in one job. Each FHIR resource carries the same field-level federal provenance as the public surfaces — the source coding system tags every resource with its originating CMS or OIG file and last-checked date — so an automated workflow inherits the same auditable chain a manual screen would produce.
- How does field-level provenance change a credentialing audit?
- In a typical credentialing stack, a provider's NPI status, enrollment, and exclusion check arrive as flattened attributes from a data vendor, with no way to show which federal file or date each value came from. When an auditor or a CMS program-integrity reviewer asks how a given screen was substantiated, the answer is often a vendor SLA rather than the underlying record. Fonteum attaches a provider_field_provenance row to every rendered fact: the source name (CMS NPPES, OIG LEIE, CMS PECOS), the date that field was last checked against the federal file, and any documented limitation of that source. The result is a per-field chain of custody back to the government record. For YMYL healthcare compliance, that means an exclusion-screening result is not just true — it is demonstrably traceable to the monthly OIG LEIE file it was drawn from, which is the standard an enforcement review or downstream payer audit expects.
- Is Fonteum's credentialing data free, and what does the pilot tier add?
- The federal datasets behind credentialing — CMS NPPES, the OIG LEIE exclusion list of 68,055+ individuals and entities, and CMS PECOS enrollment — are published openly. The exclusion surface is browsable at /sanctions and the research datasets, with CSV and JSON downloads plus methodology notes, are at /research. The FHIR R4 US Core 6.1.0 API and the HL7 bulk $export operation are documented at /docs/fhir and the CapabilityStatement at /api/fhir/metadata. Free access reflects the doctrine that public-source federal data should stay public. The scoped pilot tier, starting at $2,500/mo, adds custom exports cut to a specific provider network — for example a combined NPPES-plus-LEIE-plus-PECOS file keyed to the NPIs you credential, delivered on your screening cadence with the field-level provenance intact. The pilot is about scoping, delivery, and integration support, not about gating access to the underlying federal record.
Request a credentialing data pilot.
Scope a custom NPPES + OIG LEIE + PECOS export for your provider network. Free public data at /research and /sanctions. Pilot tier from $2,500/mo.
- /sanctions → OIG LEIE exclusion surface — 68,055+ excluded providers.
- /docs/fhir → FHIR R4 US Core 6.1.0 endpoint reference and CapabilityStatement.
- /data-provenance → Field-level provenance pipeline for NPPES, LEIE, and PECOS.
- /compare/verisys-alternative → How Fonteum compares to Verisys for exclusion monitoring.