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Aetna

Aetna Provider Directory FHIR API

HL7 FHIR R4 Provider Directory API implementing the Da Vinci PDex Plan Net Implementation Guide (upgraded to version 1.2.0 on 2026-06-23), covering both Medicare and Commercial networks. Exposes Practitioner, PractitionerRole, Organization, OrganizationAffiliation, InsurancePlan, Location and HealthcareService across two surfaces - an interactive directory at /v1/providerdirectory and a data surface at /v1/providerdirectorydata that additionally offers Bulk FHIR $export and $exportstatus. Unlike several peer payers, Aetna requires OAuth on the directory; it is not anonymously callable.

Documentation Provider Profile APIs.io OpenAPI GitHub

This API exposes 20 operations across 20 paths, and defines 10 schemas. It is described by OpenAPI 3.0.3, at version 1.0.0.

Requests are made against 2 base URLs: https://apif1.aetna.com/fhir, https://qapif1.aetna.com/fhir.

20 operations 20 paths 10 schemas 20 GET

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 3.0.3
API Version
1.0.0
Base URL
https://apif1.aetna.com/fhir
Authentication
OAuth 2.0, OAuth 2.0
Contact
Aetna Interoperability Developer Support
Resource Areas
1

Authentication & Security 2

Aetna Provider Directory FHIR API declares 2 security schemes for authenticating requests. It supports OAuth 2.0 (FHIR_User_AccessCode_Oauth) using the authorizationCode flow, exposing 4 scopes. It supports OAuth 2.0 (FHIR_Application_Oauth) using the clientCredentials flow, exposing 2 scopes.

  • FHIR_Application_Oauth — { "BuildEieHeader" : "Header 3.2", "SecurityTemplate" : "FHIROpenApp", "Backend" : "Non-IIB, FHIRServer APIGEE APIs, requires Mutual TLS", "Errorhandlingpolicy…

Paths & Operations 20

Across 20 paths, the API surfaces 20 operations — 20 GET. Each is listed below with its method, path, parameters, and response codes.

Operations 20
GET
/v1/providerdirectory/InsurancePlan
Retrieve InsurancePlan resource based on Coverage Area (Coverage area is a 2-digit state abbreviation). Both Provider and Pharmacy data are available on this resource.
get_v1_providerdirectory_InsurancePlan 1 param → 200400500
GET
/v1/providerdirectory/Location
Search all resources of type Location based on postalCode or (State and City)
get_v1_providerdirectory_Location 5 params → 200400500
GET
/v1/providerdirectory/Location/{id}
Retrieves a Location Resource based on the Unique Logical ID
get_v1_providerdirectory_Location_id 1 param → 200400404500
GET
/v1/providerdirectory/Organization
Retrieves Organization resources based on search criteria(name, location)
get_v1_providerdirectory_Organization 6 params → 200400500
GET
/v1/providerdirectory/OrganizationAffiliation
Retrieves the OrganizationAffiliation resource based on : Specialty + Location. Specialty search parameter will be the NUCC taxonomy code of the specialty. Both Provider and Pharmacy data are availab…
get_v1_providerdirectory_OrganizationAffiliation 6 params → 200400500
GET
/v1/providerdirectory/Organization/{id}
Retrieves details of a Plannet Organization Resource based on a logical id.
get_v1_providerdirectory_Organization_id 1 param → 200203400404500
GET
/v1/providerdirectory/Practitioner
Retrieve a bundle of Practitioner records based on the search criteria.
get_v1_providerdirectory_Practitioner 8 params → 200400500
GET
/v1/providerdirectory/PractitionerRole
Retrieves list of Practitioner(s) that meets specialty and location parameters
get_v1_providerdirectory_PractitionerRole 6 params → 200400500
GET
/v1/providerdirectory/Practitioner/{id}
Retrieves details of individual Practitioner(s) by Logical ID.
get_v1_providerdirectory_Practitioner_id 1 param → 200203400404500
GET
/v1/providerdirectorydata/HealthcareService
HealthCareServices offered by an organization/practitioner at a location.
get_v1_providerdirectorydata_HealthcareService 12 params → 200400401403404405429500
GET
/v1/providerdirectorydata/HealthcareService/{id}
HealthCareServices offered by a particular organization/practitioner based on given ID
get_v1_providerdirectorydata_HealthcareService_id 2 params → 200400401403404405429500
GET
/v1/providerdirectorydata/InsurancePlan
Retrieves all InsurancePlans based on the search criteria
get_v1_providerdirectorydata_InsurancePlan 12 params → 200400401403404405429500
GET
/v1/providerdirectorydata/Location/{id}
ID specific Location where healthcare services are provided.
get_v1_providerdirectorydata_Location_id 2 params → 200400401403404405429500
GET
/v1/providerdirectorydata/Location
Location where healthcare services are provided.
get_v1_providerdirectorydata_Location 13 params → 200400401403404405429500
GET
/v1/providerdirectorydata/Organization
Retrieves a Bundle of Organization Resources(Organization and/or Network profiles) based on the search criteria.
get_v1_providerdirectorydata_Organization 11 params → 200400401403404405429500
GET
/v1/providerdirectorydata/Organization/{id}
Retrieves an Organization Resources(Organization or Network profile) based on the FHIR logical ID.
get_v1_providerdirectorydata_Organization_id 2 params → 200400401403404405429500
GET
/v1/providerdirectorydata/OrganizationAffiliation
Retrieves all OrganizationAffiliations based on the search criteria
get_v1_providerdirectorydata_OrganizationAffiliation 11 params → 200400401403404405429500
GET
/v1/providerdirectorydata/Practitioner
The API provides a collection of Practitioner Profile.
get_v1_providerdirectorydata_Practitioner 8 params → 200400401403404405429500
GET
/v1/providerdirectorydata/Practitioner/{id}
The API provides a Plannet Practitioner Profile with respect to Id
get_v1_providerdirectorydata_Practitioner_id 2 params → 200400401403404405429500
GET
/v1/providerdirectorydata/PractitionerRole
Retrieves all PractitionerRoles based on the search criteria
get_v1_providerdirectorydata_PractitionerRole 12 params → 200400401403404405429500

Schemas 10

The contract defines 10 schemas that model the data the API accepts and returns. The most detailed are Entry (1 property), Bundle (1 property). Each schema is shown below with its type and property counts.

Entry
object
An entry in a bundle resource - will contain a resource(s) returned in the bundle
1 property
Bundle
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 Bundle resource. Full Documentation is available at…
1 property
OperationOutcome
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 OperationOutcome resource. Full Documentation is av…
InsurancePlan
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 InsurancePlan resource. Full Documentation is avail…
Location
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 Location resource. Full Documentation is available…
Organization
object
See the appropriate Implementation Guide for proper documentation to use. This is the HL7 FHIR Release 4.0.1 Organization resource. Full Documentation is avail…
OrganizationAffiliation
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 OrganizationAffiliation resource. Full Documentatio…
Practitioner
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 Practitioner resource. Full Documentation is availa…
PractitionerRole
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 PractitionerRole resource. Full Documentation is av…
HealthcareService
object
See the appropriate Implementation Guide for proper documentation to use This is the HL7 FHIR Release 4.0.1 HealthcareService resource. Full Documentation is a…

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

aetna-provider-directory-api-openapi.yml Raw ↑
#FHIR#Provider Directory#Da Vinci#PDex Plan Net#Bulk FHIR#Network#CMS Mandate
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API Details
ID
aetna:aetna-provider-directory-fhir-api
Base URL
https://apif1.aetna.com/fhir
Docs
https://developerportal.aetna.com/
Provider
Aetna
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