UnitedHealthcare Providers API

openapi: 3.1.0
info:
  title: UnitedHealthcare Interoperability Claims Providers API
  description: The UnitedHealthcare Interoperability APIs provide FHIR R4-compliant access to patient health data in accordance with CMS Interoperability and Patient Access final rule (CMS-9115-F). Includes Patient Access API for member health records and claims history, and Provider Directory API for network provider information. These APIs enable patients and authorized third parties to access health data using standard FHIR resources.
  version: '1.0'
  contact:
    name: UnitedHealthcare Interoperability
    url: https://www.uhc.com/legal/interoperability-apis
  license:
    name: UnitedHealthcare API Terms of Use
    url: https://www.uhc.com/legal/interoperability-apis
servers:
- url: https://api.uhc.com/fhir/R4
  description: Production FHIR R4 Endpoint
security:
- bearerAuth: []
tags:
- name: Providers
  description: Provider demographics and directory
paths:
  /providers/v1/demographics:
    get:
      operationId: getProviderDemographics
      summary: UnitedHealthcare Provider Demographics
      description: Retrieve demographic and credentialing information for healthcare providers in the UnitedHealthcare network, including contact details, specialties, network participation, and accepting new patients status.
      tags:
      - Providers
      x-microcks-operation:
        dispatcher: SCRIPT
        dispatcherRules: return 'FOUND';
      parameters:
      - name: npi
        in: query
        required: true
        description: National Provider Identifier (NPI) for the provider
        schema:
          type: string
          pattern: ^\d{10}$
      - name: state
        in: query
        required: false
        description: Two-letter state code to filter results
        schema:
          type: string
          maxLength: 2
      responses:
        '200':
          description: Provider demographic information
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ProviderDemographics'
        '400':
          description: Bad request
        '401':
          description: Unauthorized
        '404':
          description: Provider not found
        '429':
          description: Too many requests
components:
  schemas:
    ProviderDemographics:
      type: object
      description: Healthcare provider demographic and credentialing information
      properties:
        npi:
          type: string
          description: National Provider Identifier
        firstName:
          type: string
          description: Provider first name
        lastName:
          type: string
          description: Provider last name
        organizationName:
          type: string
          description: Organization name (for group practices)
        providerType:
          type: string
          enum:
          - INDIVIDUAL
          - ORGANIZATION
          description: Provider type
        specialty:
          type: string
          description: Primary specialty
        subspecialties:
          type: array
          description: List of subspecialties
          items:
            type: string
        networkStatus:
          type: string
          enum:
          - IN_NETWORK
          - OUT_OF_NETWORK
          description: Network participation status
        acceptingNewPatients:
          type: boolean
          description: Whether accepting new patients
        address:
          type: object
          description: Practice address
          properties:
            street1:
              type: string
            street2:
              type: string
            city:
              type: string
            state:
              type: string
            zip:
              type: string
        phone:
          type: string
          description: Office phone number
        languages:
          type: array
          description: Languages spoken
          items:
            type: string
        boardCertifications:
          type: array
          description: Board certifications
          items:
            type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: OAuth 2.0 Bearer token for FHIR API access
externalDocs:
  description: UnitedHealthcare Interoperability APIs Documentation
  url: https://www.uhc.com/legal/interoperability-apis