Healthcare Provider Directory

Part of the worlds-biggest-software-project initiative.

A credentialing-verified provider search and scheduling platform that replaces fragmented, error-prone healthcare directories with a FHIR-native, continuously verified data layer.

Healthcare Provider Directory is an open-source platform for health systems, payers, and medical groups that need accurate, standards-compliant provider data integrated with real-time scheduling. It addresses the persistent problem of directory inaccuracy -- studies show 30-50% of provider directory entries contain errors -- by combining authoritative public data sources with AI-driven continuous verification.

Why Healthcare Provider Directory?

Directory accuracy is broken. Incumbent directories rely on 90-day manual re-attestation cycles, leaving 30-50% of entries with stale addresses, phone numbers, or insurance acceptance data. Ghost networks -- providers listed but unable to accept bookings -- expose payers to CMS fines of up to $25K per affected beneficiary.
Enterprise incumbents are inaccessible to mid-market buyers. Platforms like Kyruus and symplr command six-figure annual contracts with nine-month deployment timelines, pricing out digital health companies, medical groups, and smaller health plans.
Consumer and credentialing are artificially separated. Zocdoc handles patient-facing search and booking but performs only shallow NPI-based credential checks. Credentialing platforms like HealthStream and Medallion verify credentials deeply but offer no patient scheduling. The gap between these two worlds is unoccupied.
Regulatory mandates are creating urgency. CMS-0057-F requires regulated payers to publish FHIR-accessible provider directories by January 2027. Many payers lack the technology to comply without expensive vendor engagements.
No open-source FHIR-native directory exists. Every current provider directory platform is proprietary. A permissively licensed FHIR Plan Net conformant directory would let payers meet the CMS mandate at minimal cost.

Key Features

Provider Search and Discovery

Specialty, location, insurance acceptance, language, and gender filtering
AI natural language search resolving conversational queries (e.g. "Spanish-speaking psychiatrist in Brooklyn who takes Medicaid")
Provider profiles with credentials, affiliations, locations, and contact data with data source attribution
Map-based search with first-available appointment highlighting

Credential Verification

Primary source verification against state licensing boards, ABMS board certification, DEA registration, and OIG exclusion lists
Continuous automated cross-validation replacing manual 90-day re-attestation cycles
Data quality scoring per provider record showing verified versus self-reported fields
CAQH ProView integration for attested provider data

Scheduling Integration

Real-time appointment availability via SMART Scheduling Links integration with Epic, athenahealth, and Oracle Health
Live slot display from major EHR scheduling modules
Patient self-booking with pre-visit insurance eligibility verification

Directory Integrity

Ghost network detection: ML-based flagging of listings where scheduling data, contact accuracy, and address validity suggest the provider cannot accept bookings
Automated NPPES NPI data refresh on weekly cadence
Insurance panel data aggregated from major payer FHIR Directory APIs
Webhook-based update notifications when provider data changes

Compliance and Standards

FHIR R4 Provider Directory API conformant with Da Vinci PDex Plan Net
CMS-0057-F compliance for regulated payer directory publication
HIPAA-compliant architecture with audit logging for patient-linked queries
CMS Plan Finder data submission workflow for Medicare Advantage directories

AI-Native Advantage

AI transforms provider directory management from a periodic, manual data-hygiene exercise into a continuous, autonomous verification system. AI agents query licensing boards, DEA, OIG, and NPDB databases in real time to verify credentials without manual follow-up. Machine learning models predict credentialing timelines based on provider type, jurisdiction, and historical patterns -- compressing the industry average from 90-120 days to under 30. NLP-powered directory correction parses unstructured provider data from payer PDFs, provider websites, and clinical notes at 93%+ precision, while network adequacy analytics automatically identify coverage gaps by geography, specialty, and patient demand.

Tech Stack & Deployment

Standards: FHIR R4 with Da Vinci PDex Plan Net and US Core implementation guides; HL7 NDH (National Directory of Healthcare Providers); SMART Scheduling Links for EHR slot discovery
Base data layer: NPPES NPI Registry (public domain, 7M+ active NPIs) with automated weekly refresh from CMS bulk downloads
Integrations: Epic, Oracle Health, athenahealth, and Meditech EHR systems; Availity and clearinghouse eligibility APIs; state licensing board APIs for primary source verification
Deployment: Self-hosted or cloud; HIPAA-compliant architecture required for any patient-linked queries (Business Associate Agreements apply)
Regulatory alignment: ONC 21st Century Cures Act information blocking rules; CMS Interoperability and Patient Access Final Rule; NCQA credentialing accreditation standards

Market Context

The healthcare credentialing software and services market is valued at approximately USD 1.09 billion in 2026, projected to reach USD 2.26 billion by 2035 (Grand View Research, CAGR ~8.5%). The broader payer network management market is projected to grow from USD 4.89 billion to USD 9.72 billion by 2034 (Fortune Business Insights). Enterprise platforms command USD 100K-1M+ annually, while mid-market tools like NexHealth start at USD 299/month. Primary buyers include health system credentialing staff, payer network management teams, medical group administrators, and healthcare IT teams integrating provider data across EHR, billing, and scheduling systems.

Project Status

This project is in the research and specification phase.
Contributions, feedback, and domain expertise are welcome.

Contributing

We welcome contributions from developers, domain experts, and potential users. See CONTRIBUTING.md for guidelines.

Important: All contributions must be your own original work or clearly attributed open-source material with a compatible licence. Copyright infringement and licence violations will not be tolerated and will result in immediate removal of the offending contribution. If you are unsure whether a piece of code, text, or other material is safe to contribute, open an issue and ask before submitting.

Licence

Licence to be determined. See discussion for context. Note: NPPES NPI data is US government public domain with no licensing restrictions. FHIR standards are W3C-licensed with royalty-free use for conformant implementations.