Centene Provider RTR Demographics API

The Provider RTR Demographics API exposes Centene’s provider record — credentialing, accreditation, contracting, network participation and business identifiers — across 67 read operations and 151 schemas. It is Centene’s bespoke provider model, not FHIR, and no published crosswalk maps it to the FHIR Provider Directory. Access is OAuth client credentials with audience prtrdemographic.

Operations 67

GET /businessfunction/v1/practitioner/date #
GET /businessfunction/v1/practitioner/date/health #
GET /businessfunction/v1/practitioner/date/version #
GET /businessfunction/v1/provider/date #
GET /businessfunction/v1/provider/date/health #
GET /businessfunction/v1/provider/date/version #
GET /provRTR/v2/practitioner #
GET /provRTR/v2/practitioner/health #
GET /provRTR/v2/practitioner/location #
GET /provRTR/v2/practitioner/network #
GET /provRTR/v2/practitioner/network/businessunit #
GET /provRTR/v2/practitioner/network/businessunit/search #
GET /provRTR/v2/practitioner/network/carrier #
GET /provRTR/v2/practitioner/network/carrier/search #
GET /provRTR/v2/practitioner/network/health #
GET /provRTR/v2/practitioner/network/healthplan #
GET /provRTR/v2/practitioner/network/healthplan/search #
GET /provRTR/v2/practitioner/network/plans #
GET /provRTR/v2/practitioner/network/product #
GET /provRTR/v2/practitioner/network/version #
GET /provRTR/v2/practitioner/network/{BUSINESS_UNIT_CODE} #
GET /provRTR/v2/practitioner/network/{BUSINESS_UNIT_CODE}/{HEALTH_PLAN_CODE} #
GET /provRTR/v2/practitioner/network/{BUSINESS_UNIT_CODE}/{HEALTH_PLAN_CODE}/{PRODUCT_CODE} #
GET /provRTR/v2/practitioner/network/{PRAC_ID}/businessunit #
GET /provRTR/v2/practitioner/network/{PRAC_ID}/carrier #
GET /provRTR/v2/practitioner/network/{PRAC_ID}/healthplan #
GET /provRTR/v2/practitioner/search #
GET /provRTR/v2/practitioner/search/health #
GET /provRTR/v2/practitioner/search/version #
GET /provRTR/v2/practitioner/version #
GET /provRTR/v2/practitioner/{PRAC_ID} #
GET /provRTR/v2/practitioner/{PRAC_ID}/location #
GET /provRTR/v2/practitioner/{PRAC_ID}/location/primary #
GET /provRTR/v2/practitioner/{PRAC_ID}/location/{LOCATION_ID} #
GET /provRTR/v2/provider #
GET /provRTR/v2/provider/health #
GET /provRTR/v2/provider/location #
GET /provRTR/v2/provider/location/affiliation #
GET /provRTR/v2/provider/network #
GET /provRTR/v2/provider/network/businessunit #
GET /provRTR/v2/provider/network/businessunit/search #
GET /provRTR/v2/provider/network/carrier #
GET /provRTR/v2/provider/network/carrier/search #
GET /provRTR/v2/provider/network/health #
GET /provRTR/v2/provider/network/healthplan #
GET /provRTR/v2/provider/network/healthplan/search #
GET /provRTR/v2/provider/network/plans #
GET /provRTR/v2/provider/network/product #
GET /provRTR/v2/provider/network/product/search #
GET /provRTR/v2/provider/network/version #
GET /provRTR/v2/provider/network/{PROV_ID}/businessunit #
GET /provRTR/v2/provider/network/{PROV_ID}/carrier #
GET /provRTR/v2/provider/network/{PROV_ID}/healthplan #
GET /provRTR/v2/provider/network/{PROV_ID}/product #
GET /provRTR/v2/provider/network/{{businessUnitCode}} #
GET /provRTR/v2/provider/network/{{businessUnitCode}}/{{healthPlanCode}} #
GET /provRTR/v2/provider/network/{{businessUnitCode}}/{{healthPlanCode}}/{{productCode}} #
GET /provRTR/v2/provider/search #
GET /provRTR/v2/provider/search/health #
GET /provRTR/v2/provider/search/version #
GET /provRTR/v2/provider/version #
GET /provRTR/v2/provider/{PROV_ID} #
GET /provRTR/v2/provider/{PROV_ID}/location #
GET /provRTR/v2/provider/{PROV_ID}/location/primary #
GET /provRTR/v2/provider/{PROV_ID}/location/{LOCATION_ID} #
GET /v2/practitioner/network/product/search #
GET /v2/practitioner/network/{PRAC_ID}/product #

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OpenAPI Specification

centene-provider-rtr-demographics-openapi.json Raw ↑
{
  "components": {
    "schemas": {
      "ACAEligibility": {
        "properties": {
          "ACAymdtrans": {
            "format": "date-time",
            "type": "string"
          },
          "attestationDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "AttestationDate"
          },
          "effectiveDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EffectiveDate"
          },
          "healthPlan": {
            "type": "string",
            "x-go-name": "HealthPlan"
          },
          "isACAPaymentEligible": {
            "type": "string",
            "x-go-name": "IsACAPaymentEligible"
          },
          "qualifier": {
            "type": "string",
            "x-go-name": "Qualifier"
          },
          "region": {
            "type": "string",
            "x-go-name": "Region"
          },
          "termDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "TermDate"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/practitioner"
      },
      "ADA": {
        "properties": {
          "exteriorBuilding": {
            "$ref": "#/components/schemas/ExteriorBuilding"
          },
          "interiorBuilding": {
            "$ref": "#/components/schemas/InteriorBuilding"
          },
          "parking": {
            "$ref": "#/components/schemas/Parking"
          },
          "programmaticAccess": {
            "$ref": "#/components/schemas/ProgrammaticAccess"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/providerLocation"
      },
      "ADAIndicator": {
        "properties": {
          "isASL": {
            "type": "string",
            "x-go-name": "IsASL"
          },
          "isBasicAccess": {
            "type": "string",
            "x-go-name": "IsBasicAccess"
          },
          "isExamTableScale": {
            "type": "string",
            "x-go-name": "IsExamTableScale"
          },
          "isExterior": {
            "type": "string",
            "x-go-name": "IsExterior"
          },
          "isInterior": {
            "type": "string",
            "x-go-name": "IsInterior"
          },
          "isLimitedAccess": {
            "type": "string",
            "x-go-name": "IsLimitedAccess"
          },
          "isMedEquipAccess": {
            "type": "string",
            "x-go-name": "IsMedEquipAccess"
          },
          "isMeetsAdaAccessibility": {
            "type": "string",
            "x-go-name": "IsMeetsADAAccessibility"
          },
          "isParking": {
            "type": "string",
            "x-go-name": "IsParking"
          },
          "isPatientArea": {
            "type": "string",
            "x-go-name": "IsPatientArea"
          },
          "isPatientDiagnost": {
            "type": "string",
            "x-go-name": "IsPatientDiagnost"
          },
          "isRestroom": {
            "type": "string",
            "x-go-name": "IsRestroom"
          },
          "isTTY": {
            "type": "string",
            "x-go-name": "IsTTY"
          },
          "isTransHalfMile": {
            "type": "string",
            "x-go-name": "IsTransHalfMile"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "Accreditation": {
        "properties": {
          "accredLevel": {
            "type": "string",
            "x-go-name": "AccredLevel"
          },
          "accredType": {
            "type": "string",
            "x-go-name": "AccredType"
          },
          "effectiveDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EffectiveDate"
          },
          "expirationDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "ExpirationDate"
          },
          "isAccredited": {
            "type": "string",
            "x-go-name": "IsAccredited"
          },
          "type": {
            "type": "string",
            "x-go-name": "Type"
          },
          "validationDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "ValidationDate"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "Accreditations": {
        "properties": {
          "cliaAccreditation": {
            "items": {
              "$ref": "#/components/schemas/CLIAAccreditation"
            },
            "type": "array",
            "x-go-name": "CLIA"
          },
          "hcbsAccreditation": {
            "items": {
              "$ref": "#/components/schemas/HCBSAccreditation"
            },
            "type": "array",
            "x-go-name": "HCBS"
          },
          "hcfAccreditation": {
            "items": {
              "$ref": "#/components/schemas/Accreditation"
            },
            "type": "array",
            "x-go-name": "HCF"
          },
          "ncqAccreditation": {
            "items": {
              "$ref": "#/components/schemas/Accreditation"
            },
            "type": "array",
            "x-go-name": "NCQ"
          },
          "tjcAccreditation": {
            "items": {
              "$ref": "#/components/schemas/Accreditation"
            },
            "type": "array",
            "x-go-name": "TJC"
          },
          "uraAccreditation": {
            "items": {
              "$ref": "#/components/schemas/Accreditation"
            },
            "type": "array",
            "x-go-name": "URA"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "AdditionalAddresses": {
        "properties": {
          "addressId": {
            "type": "string",
            "x-go-name": "AddressId"
          },
          "addressLine1": {
            "type": "string",
            "x-go-name": "AddressLine1"
          },
          "addressLine2": {
            "type": "string",
            "x-go-name": "AddressLine2"
          },
          "city": {
            "type": "string",
            "x-go-name": "City"
          },
          "country": {
            "type": "string",
            "x-go-name": "Country"
          },
          "county": {
            "type": "string",
            "x-go-name": "County"
          },
          "endDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EndDate"
          },
          "geoCoords": {
            "$ref": "#/components/schemas/GeoCoords"
          },
          "phoneNumbers": {
            "items": {
              "$ref": "#/components/schemas/PhoneNumbers"
            },
            "type": "array",
            "x-go-name": "PhoneNumbers"
          },
          "startDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "StartDate"
          },
          "state": {
            "type": "string",
            "x-go-name": "State"
          },
          "stateCode": {
            "type": "string",
            "x-go-name": "StateCode"
          },
          "type": {
            "type": "string",
            "x-go-name": "Type"
          },
          "zipCode": {
            "type": "string",
            "x-go-name": "ZipCode"
          },
          "zipPlus4": {
            "type": "string",
            "x-go-name": "ZipPlus4"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "Address": {
        "properties": {
          "addressId": {
            "type": "string",
            "x-go-name": "AddressID"
          },
          "addressLine1": {
            "type": "string",
            "x-go-name": "AddressLine1"
          },
          "addressLine2": {
            "type": "string",
            "x-go-name": "AddressLine2"
          },
          "billingPhoneNumbers": {
            "items": {
              "$ref": "#/components/schemas/BillingPhoneNumbers"
            },
            "type": "array",
            "x-go-name": "BillingPhoneNumbers"
          },
          "city": {
            "type": "string",
            "x-go-name": "City"
          },
          "cityId": {
            "type": "string",
            "x-go-name": "CityId"
          },
          "country": {
            "type": "string",
            "x-go-name": "Country"
          },
          "county": {
            "type": "string",
            "x-go-name": "County"
          },
          "countyId": {
            "type": "string",
            "x-go-name": "CountyId"
          },
          "endDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EndDate"
          },
          "fipsCountyCode": {
            "type": "string",
            "x-go-name": "FipsCountyCode"
          },
          "geoCoords": {
            "$ref": "#/components/schemas/GeoCoords"
          },
          "startDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "StartDate"
          },
          "state": {
            "type": "string",
            "x-go-name": "State"
          },
          "stateCode": {
            "type": "string",
            "x-go-name": "StateCode"
          },
          "type": {
            "type": "string",
            "x-go-name": "Type"
          },
          "zipCode": {
            "type": "string",
            "x-go-name": "ZipCode"
          },
          "zipPlus4": {
            "type": "string",
            "x-go-name": "Zip4"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "AdvancedMedicalHomeTier": {
        "properties": {
          "effectiveDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EffectiveDate"
          },
          "endDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EndDate"
          },
          "healthPlan": {
            "type": "string",
            "x-go-name": "HealthPlan"
          },
          "tier": {
            "type": "string",
            "x-go-name": "Tier"
          },
          "tierType": {
            "type": "string",
            "x-go-name": "TierType"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "Affiliation": {
        "properties": {
          "absSuffix": {
            "type": "string",
            "x-go-name": "AbsSuffix"
          },
          "accept": {
            "type": "string",
            "x-go-name": "Accept"
          },
          "active": {
            "type": "string",
            "x-go-name": "Active"
          },
          "affiliatedAgency": {
            "type": "string",
            "x-go-name": "AffiliatedAgency"
          },
          "affiliationNumber": {
            "type": "string",
            "x-go-name": "AffiliationNumber"
          },
          "altProviderType": {
            "type": "string",
            "x-go-name": "AltProviderType"
          },
          "altProviderTypeDescription": {
            "type": "string",
            "x-go-name": "AltProviderTypeDescription"
          },
          "altSpec1": {
            "type": "string",
            "x-go-name": "AltSpec1"
          },
          "altSpec1Description": {
            "type": "string",
            "x-go-name": "AltSpec1Description"
          },
          "alternateQualifier": {
            "type": "string",
            "x-go-name": "AlternateQualifier"
          },
          "area": {
            "type": "string",
            "x-go-name": "Area"
          },
          "businessUnit": {
            "type": "string",
            "x-go-name": "BusinessUnit"
          },
          "capCycle": {
            "type": "string",
            "x-go-name": "CapCycle"
          },
          "capKey": {
            "type": "string",
            "x-go-name": "CapKey"
          },
          "capMethod": {
            "type": "string",
            "x-go-name": "CapMethod"
          },
          "capStatus": {
            "type": "string",
            "x-go-name": "CapStatus"
          },
          "capType": {
            "type": "string",
            "x-go-name": "CapType"
          },
          "carrier": {
            "type": "string",
            "x-go-name": "Carrier"
          },
          "claimType": {
            "type": "string",
            "x-go-name": "ClaimType"
          },
          "classX": {
            "type": "string",
            "x-go-name": "ClassX"
          },
          "cnrReason": {
            "type": "string",
            "x-go-name": "CnrReason"
          },
          "cnrReasonDescription": {
            "type": "string",
            "x-go-name": "CnrReasonDescription"
          },
          "county": {
            "type": "string",
            "x-go-name": "County"
          },
          "credRequired": {
            "type": "string",
            "x-go-name": "CredRequired"
          },
          "deaNumber": {
            "type": "string",
            "x-go-name": "DeaNumber"
          },
          "endDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EndDate"
          },
          "exceptionFee": {
            "type": "string",
            "x-go-name": "ExceptionFee"
          },
          "fundClass": {
            "type": "string",
            "x-go-name": "FundClass"
          },
          "groupPracticeNumber": {
            "type": "string",
            "x-go-name": "GroupPracticeNumber"
          },
          "hatCode": {
            "type": "string",
            "x-go-name": "HatCode"
          },
          "hatCodeDescription": {
            "type": "string",
            "x-go-name": "HatCodeDescription"
          },
          "irsNumber": {
            "type": "string",
            "x-go-name": "IRSNumber"
          },
          "lag": {
            "type": "string",
            "x-go-name": "Lag"
          },
          "losRegion": {
            "type": "string",
            "x-go-name": "LosRegion"
          },
          "medicaidNumber": {
            "type": "string",
            "x-go-name": "MedicaidNumber"
          },
          "medicareNumber": {
            "type": "string",
            "x-go-name": "MedicareNumber"
          },
          "npi": {
            "type": "string",
            "x-go-name": "NPI"
          },
          "officeNumber": {
            "type": "string",
            "x-go-name": "OfficeNumber"
          },
          "overrideKey": {
            "type": "string",
            "x-go-name": "OverrideKey"
          },
          "patientLoad": {
            "type": "string",
            "x-go-name": "PatientLoad"
          },
          "payClass": {
            "type": "string",
            "x-go-name": "PayClass"
          },
          "payDiscount": {
            "type": "string",
            "x-go-name": "PayDiscount"
          },
          "payTo": {
            "type": "string",
            "x-go-name": "PayTo"
          },
          "periodTable": {
            "type": "string",
            "x-go-name": "PeriodTable"
          },
          "pnlcAId": {
            "type": "string",
            "x-go-name": "PnlcAID"
          },
          "pnlcId": {
            "type": "string",
            "x-go-name": "PnlcID"
          },
          "poolClass": {
            "type": "string",
            "x-go-name": "PoolClass"
          },
          "program": {
            "type": "string",
            "x-go-name": "Program"
          },
          "providerId": {
            "type": "string",
            "x-go-name": "ProviderId"
          },
          "providerType": {
            "type": "string",
            "x-go-name": "ProviderType"
          },
          "providerTypeDescription": {
            "type": "string",
            "x-go-name": "ProviderTypeDescription"
          },
          "region": {
            "type": "string",
            "x-go-name": "Region"
          },
          "scaleClass": {
            "type": "string",
            "x-go-name": "ScaleClass"
          },
          "spec1": {
            "type": "string",
            "x-go-name": "Spec1"
          },
          "spec1Description": {
            "type": "string",
            "x-go-name": "Spec1Description"
          },
          "startDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "StartDate"
          },
          "status": {
            "type": "string",
            "x-go-name": "Status"
          },
          "statusDescription": {
            "type": "string",
            "x-go-name": "StatusDescription"
          },
          "subProgram": {
            "type": "string",
            "x-go-name": "SubProgram"
          },
          "taxonomy": {
            "$ref": "#/components/schemas/Taxonomy"
          }
        },
        "type": "object",
        "x-go-package": "gitlab.centene.com/rtr/provider-rtr/provider-rtr-apis/models/shared"
      },
      "Agreement": {
        "properties": {
          "agreementId": {
            "type": "string",
            "x-go-name": "AgreementId"
          },
          "agreementType": {
            "type": "string",
            "x-go-name": "AgreementType"
          },
          "endDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "EndDate"
          },
          "facetsPracId": {
            "type": "string",
            "x-go-name": "FacetsPracId"
          },
          "primaryLoc": {
            "type": "string",
            "x-go-name": "PrimaryLoc"
          },
          "startDate": {
            "format": "date-time",
            "type": "string",
            "x-go-name": "StartDate"
          },
          "taxonomy": {
            "type": "string",
            "x-go-name": "Taxonomy"
          },
          "termReason": {
            "type": "string",
            "x-go-name": "TermReason"
          },
          "termReasonDescription": {
            "type": "string",
            "x-go-name": "TermReasonDescription"
          },
          "title": {
            "type": "string",
            "x-go-name": "Title"
          }
        },
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# Full source: https://raw.githubusercontent.com/api-evangelist/centene/refs/heads/main/openapi/centene-provider-rtr-demographics-openapi.json