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Centene

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.

Documentation Provider Profile APIs.io OpenAPI GitHub

Centene Provider RTR Demographics API is one of 12 APIs that Centene publishes on the APIs.io network, described by a machine-readable OpenAPI specification.

Tagged areas include Provider, Demographics, Credentialing, and Payer. The published artifact set on APIs.io includes API documentation and an OpenAPI specification.

This API exposes 67 operations across 67 paths, organized into 8 resource areas, and defines 151 schemas. It is described by OpenAPI 3.0.3, at version 2.0.

Requests are made against 3 base URLs: https://dev-int-api-gw.centene.com/provider-rtr/demographics/, https://test-int-api-gw.centene.com/provider-rtr/demographics/, https://api-gateway-01.centene.com/provider-rtr/demographics/.

67 operations 67 paths 151 schemas 67 GET

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 3.0.3
API Version
2.0
Base URL
https://api-gateway-01.centene.com/provider-rtr/demographics/
Authentication
OAuth 2.0
Resource Areas
8

Authentication & Security 1

Centene Provider RTR Demographics API declares 1 security scheme for authenticating requests. It supports OAuth 2.0 (oauth2) using the clientCredentials flow, exposing 1 scope. By default, every request must be authenticated.

Paths & Operations 67

Across 67 paths, the API surfaces 67 operations — 67 GET. They span 8 resource areas: Practitioner-Date-API, Provider-Date-API, Practitioner-API, Practitioner-Network-API, Practitioner-Search-API, Provider-API, Provider-Network-API, Provider-Search-API. Each is listed below with its method, path, parameters, and response codes.

Practitioner-Date-API 3

RESTful API endpoints for search Practitioners' date related information. More information can be found on the corresponding Alation page: https://alation.centene.com/table/538096/

GET
/businessfunction/v1/practitioner/date
Find Active Practitioners given a combination of different dates at different levels, such as: location, network location, network, affiliations. At least npi, tin, affiliationNumber, affiliationMedi…
GetPractitionersByDate 22 params → 200400403500504
GET
/businessfunction/v1/practitioner/date/health
Health Check
GetPractitionerDateHealth → 200403424500504
GET
/businessfunction/v1/practitioner/date/version
Version Information
GetPractitionerDateVersion → 200403500504
Provider-Date-API 3

RESTful API endpoints for search Providers' date related information. More information can be found on the corresponding Alation page: https://alation.centene.com/table/538089/

GET
/businessfunction/v1/provider/date
Find Active Providers given a combination of different dates at different levels such as: location, network location, network, affiliations. At least npi, tin, affiliationNumber, affiliationMedicaidI…
GetProvidersByDate 25 params → 200403404500504
GET
/businessfunction/v1/provider/date/health
Health Check
GetProviderDateHealth → 200403424500504
GET
/businessfunction/v1/provider/date/version
Version Information
GetProviderDateVersion → 200403500504
Practitioner-API 8

RESTful API endpoints for search Practitioners' and their networks/locations related information. More information can be found on the corresponding Alation page: https://alation.…

GET
/provRTR/v2/practitioner
Looks up a practitioner matching all of the query parameters. At least npi, phyId, or amisysNumber are required to use
GetPractitionerSearch 6 params → 200403500504
GET
/provRTR/v2/practitioner/health
Health Check
GetPractitionerHealth → 200403424500504
GET
/provRTR/v2/practitioner/location
Look up practitioner locations matching the search criteria. At least provide npi, tin, affiliationNumber, affiliationMedicaidId, affiliationMedicareId, provNpi, medicalLicenseNumber, amisysNumber, o…
GetPractitionerLocationSearch 17 params → 200403500504
GET
/provRTR/v2/practitioner/version
Version Information
GetPractitionerVersion → 200403500504
GET
/provRTR/v2/practitioner/{PRAC_ID}
Find Practitioners with the given PracId Note: Does not include locations data on the response; Need to add "includeLocations":"true" in the select params; or Please use other endpoint including "pro…
GetPractitioner 2 params → 200403404500504
GET
/provRTR/v2/practitioner/{PRAC_ID}/location
Look up all locations for practitioner matching the Practitioner Id
GetPractitionerAllLocations 2 params → 200404
GET
/provRTR/v2/practitioner/{PRAC_ID}/location/primary
Find Practitioners with the given PracId and its primary location
GetPractitionerLocationPrimary 2 params → 200403404500504
GET
/provRTR/v2/practitioner/{PRAC_ID}/location/{LOCATION_ID}
Find Practitioners with the given PracId and location matching LocationId
GetPractitionerLocation 3 params → 200403404500504
Practitioner-Network-API 19

RESTful API endpoints for search Practitioners' network related information. More information can be found on the corresponding Alation page: https://alation.centene.com/table/538…

GET
/provRTR/v2/practitioner/network
Look up practitioner location networks matching the search criteria. At least npi, tin, provNpi, or affiliationNumber are required to use
GetPractitionerNetworkPlan 9 params → 200400403500504
GET
/provRTR/v2/practitioner/network/businessunit
Look up practitioner location networks matching the search criteria. At least npi, provNpi, tin, or affiliationNumber are required to use in combination with a valid Business Unit NetworkId
GetPractitionerNetworkBusinessUnitNetworkId 10 params → 200400403500504
GET
/provRTR/v2/practitioner/network/businessunit/search
Look up practitioner location networks matching the search criteria. At least firstName and / or lastName and at least one valid businessUnit networkId is required to use
GetPractitionerNetworkBusinessUnitSearch 6 params → 200400403500504
GET
/provRTR/v2/practitioner/network/carrier
Look up practitioner location networks matching the search criteria. At least npi, provNpi, tin, affiliationMedicaidId, or affiliationNumber are required to use. NetworkId is a must in combination wi…
GetPractitionerNetworkCarrierNetworkId 11 params → 200400403500504
GET
/provRTR/v2/practitioner/network/carrier/search
Look up practitioner location networks matching the search criteria. At least firstName or lastName and one valid networkId is required to use
GetPractitionerNetworkCarrierSearch 6 params → 200400403500504
GET
/provRTR/v2/practitioner/network/health
Health Check
GetPractitionerNetworkHealth → 200403424500504
GET
/provRTR/v2/practitioner/network/healthplan
Look up practitioner location networks matching the search criteria. At least npi, provNpi, tin, or affiliationNumber are required to use in combination with valid NetworkId
GetPractitionerNetworkHealthPlanNetworkId 10 params → 200400403500504
GET
/provRTR/v2/practitioner/network/healthplan/search
Look up practitioner location networks matching the search criteria. At least firstName and / or lastName and at least one valid networkId is required to use
GetPractitionerNetworkHealthPlanSearch 6 params → 200400403500504
GET
/provRTR/v2/practitioner/network/plans
Search for practitioners matching all criteria. At least tin is required to use
GetPractitionerNetworkPlansPath 5 params → 200400403500504
GET
/provRTR/v2/practitioner/network/product
Look up practitioner location networks matching the search criteria. At least npi, provNpi, tin, amisysNumber, or affiliationNumber are required to use with the combination of networkId
GetPractitionerNetworkProductNetworkId 11 params → 200400403500504
GET
/provRTR/v2/practitioner/network/version
Version Information
GetPractitionerNetworkVersion → 200403500504
GET
/provRTR/v2/practitioner/network/{BUSINESS_UNIT_CODE}
Look up practitioner location networks matching the search criteria. At least npi, provNpi, tin, or affiliationNumber are required to use
GetPractitionerNetworkBusinessUnitCode 10 params → 200400403500504
GET
/provRTR/v2/practitioner/network/{BUSINESS_UNIT_CODE}/{HEALTH_PLAN_CODE}
Look up practitioner location networks matching the search criteria. At least npi, tin, provNpi, or affiliationNumber are required to use
GetPractitionerNetworkHealthPlanCode 11 params → 200400403500504
GET
/provRTR/v2/practitioner/network/{BUSINESS_UNIT_CODE}/{HEALTH_PLAN_CODE}/{PRODUCT_CODE}
Look up practitioner location networks matching the search criteria. At least npi, provNpi, tin, or affiliationNumber are required to use
GetPractitionerNetworkProductCode 12 params → 200400403500504
GET
/provRTR/v2/practitioner/network/{PRAC_ID}/businessunit
Look up practitioner location networks matching the search criteria. {PRACID} and at least one valid Business Unit networkId is required to use
GetPractitionerByIdBusinessUnitNetwork 5 params → 200400403500504
GET
/provRTR/v2/practitioner/network/{PRAC_ID}/carrier
Look up practitioner location networks matching the search criteria. {PRACID} and at least one valid Carrier networkId is required to use
GetPractitionerByIdCarrierNetworkId 5 params → 200400403500504
GET
/provRTR/v2/practitioner/network/{PRAC_ID}/healthplan
Look up practitioner location networks matching the search criteria. {PRACID} and at least one valid Health Plan networkId is required to use
GetPractitionerByIdHealthPlanNetwork 5 params → 200400403500504
GET
/v2/practitioner/network/product/search
Look up practitioner location networks matching the search criteria. At least firstName and / or lastName and at least one valid networkId is required to use
GetPractitionerNetworkProductNetworkSearch 6 params → 200400403500504
GET
/v2/practitioner/network/{PRAC_ID}/product
Look up practitioner location networks matching the search criteria. {PRACID} and at least one valid Product networkId is required to use
GetPractitionerByIdProductNetwork 5 params → 200400403500504
Practitioner-Search-API 3

RESTful API endpoints for search Practitioners' related information. More information can be found on the corresponding Alation page: https://alation.centene.com/table/538096/

GET
/provRTR/v2/practitioner/search
Find Practitioners with a given first name and / or last name
SearchPractitioner 5 params → 200400403500504
GET
/provRTR/v2/practitioner/search/health
Health Check
GetPracSearchHealth → 200403424500504
GET
/provRTR/v2/practitioner/search/version
Version Information
GetPracSearchHVersion → 200403500504
Provider-API 9

RESTful API endpoints for search Providers' and their networks/locations related information. More information can be found on the corresponding Alation page: https://alation.cent…

GET
/provRTR/v2/provider
Search for providers matching all criteria. At least npi, tin, ppgId, or amisysNumber are requored to use Note: Does not include locations data on the response, Please use other endpoint including "/…
GetProviderSearch 8 params → 200400403500504
GET
/provRTR/v2/provider/health
Health Check
GetProviderHealth → 200403424500504
GET
/provRTR/v2/provider/location
Search for Providers with locations that match the criteria. At least npi, tin, affiliationNumber, affiliationMedicaidId, affiliationMedicareId, amisysNumber, or ppgId are required to use
ProviderLocationSearch 15 params → 200400403500504
GET
/provRTR/v2/provider/location/affiliation
Deprecated, use the appropriate "/network/{BUSINESSUNITCODE}" endpoint with "affiliationNumber" query parameter instead.
GetProviderAffiliation 4 params → 200400403500504
GET
/provRTR/v2/provider/version
Version Information
GetProviderVersion → 200403500504
GET
/provRTR/v2/provider/{PROV_ID}
Look up the provider matching the Provider Id
GetProvider 3 params → 200403404500504
GET
/provRTR/v2/provider/{PROV_ID}/location
Look up all locations for the provider matching the Provider Id
GetProviderAllLocations 3 params → 200403404500504
GET
/provRTR/v2/provider/{PROV_ID}/location/primary
Find a provider and it's primary location
GetProviderLocationPrimary 3 params → 200403404500504
GET
/provRTR/v2/provider/{PROV_ID}/location/{LOCATION_ID}
Find a provider and location that match the identifiers
GetProviderLocation 4 params → 200403404500504
Provider-Network-API 19

RESTful API endpoints for search Providers' network related information. More information can be found on the corresponding Alation page: https://alation.centene.com/table/538089/

GET
/provRTR/v2/provider/network
Look up provider location networks matching the search criteria. At least npi, tin, or affiliationNumber are required to use
GetProviderNetworkPlan 8 params → 200400403500504
GET
/provRTR/v2/provider/network/businessunit
Look up provider location networks matching the search criteria. At least npi, tin, or affiliationNumber are required to use in combination with a valid BusinessUnit NetworkId
GetProviderNetworkBusinessUnitNetworkId 9 params → 200400403500504
GET
/provRTR/v2/provider/network/businessunit/search
Look up provider location networks matching the search criteria. At least name and one valid businessUnit networkId is required to use
GetProviderNetworkBusinessUnitSearch 5 params → 200400403500504
GET
/provRTR/v2/provider/network/carrier
Look up provider location networks matching the search criteria. At least npi, tin, ppgId, or affiliationNumber and at least one valid carrier networkId is required to use
GetProviderNetworkCarrierNetworkId 10 params → 200400403500504
GET
/provRTR/v2/provider/network/carrier/search
Look up provider location networks matching the search criteria. At least name and one valid carrier networkId is required to use
GetProviderNetworkCarrierSearch 5 params → 200400403500504
GET
/provRTR/v2/provider/network/health
Health Check
GetProviderNetworkHealth → 200403424500504
GET
/provRTR/v2/provider/network/healthplan
Look up provider location networks matching the search criteria. At least npi, tin, or affiliationNumber are required to use in combination with a valid healthPlan NetworkId
GetProviderNetworkHealthPlanNetworkId 9 params → 200400403500504
GET
/provRTR/v2/provider/network/healthplan/search
Look up provider location networks matching the search criteria. At least name and one valid healthPlan networkId is required to use
GetProviderNetworkHealthPlanSearch 5 params → 200400403500504
GET
/provRTR/v2/provider/network/plans
Search for providers matching all criteria. At least tin is required to use
GetProviderNetworkPlansPath 5 params → 200400403500504
GET
/provRTR/v2/provider/network/product
Look up provider location networks matching the search criteria. At least npi, tin, amisysNumber, or affiliationNumber are required to use in combination with a valid product networkId
GetProviderNetworkProductNetworkId 9 params → 200400403500504
GET
/provRTR/v2/provider/network/product/search
Look up provider location networks matching the search criteria. At least name and one valid product networkId is required to use
GetProviderNetworkProductSearch 5 params → 200400403500504
GET
/provRTR/v2/provider/network/version
Version Information
GetProviderNetworkVersion → 200403500504
GET
/provRTR/v2/provider/network/{PROV_ID}/businessunit
Look up provider location networks matching the search criteria. {PROVID} and at least one valid Business Unit networkId is required to use
GetProviderByIdBusinessUnitNetwork 5 params → 200400403500504
GET
/provRTR/v2/provider/network/{PROV_ID}/carrier
Look up provider location networks matching the search criteria. {PROVID} and at least one valid Carrier networkId is required to use
GetProviderByIdCarrierNetworkId 5 params → 200400403500504
GET
/provRTR/v2/provider/network/{PROV_ID}/healthplan
Look up provider location networks matching the search criteria. {PROVID} and at least one valid Health Plan networkId is required to use
GetProviderByIdHealthPlanNetwork 5 params → 200400403500504
GET
/provRTR/v2/provider/network/{PROV_ID}/product
Look up provider location networks matching the search criteria. {PROVID} and at least one valid Product networkId is required to use
GetProviderByIdProductNetwork 5 params → 200400403500504
GET
/provRTR/v2/provider/network/{{businessUnitCode}}
Look up provider location networks matching the search criteria. At least npi, tin, or affiliationNumber are required to use
GetProviderNetworkBusinessUnitCode 9 params → 200400403500504
GET
/provRTR/v2/provider/network/{{businessUnitCode}}/{{healthPlanCode}}
Look up provider location networks matching the search criteria. At least npi, tin, or affiliationNumber are required to use
GetProviderNetworkHealthPlanCode 10 params → 200400403500504
GET
/provRTR/v2/provider/network/{{businessUnitCode}}/{{healthPlanCode}}/{{productCode}}
Look up provider location networks matching the search criteria. At least npi, tin, or affiliationNumber are required to use
GetProviderNetworkProductCode 11 params → 200400403500504
Provider-Search-API 3

RESTful API endpoints for search Providers' related information. More information can be found on the corresponding Alation page: https://alation.centene.com/table/538089/

GET
/provRTR/v2/provider/search
Find Providers with the matching provider name. At least name is required to use
SearchProvider 4 params → 200400403404500504
GET
/provRTR/v2/provider/search/health
Health Check
GetProviderSearchHealth → 200403424500504
GET
/provRTR/v2/provider/search/version
Version Information
GetProviderSearchVersion → 200403500504

Schemas 151

The contract defines 151 schemas that model the data the API accepts and returns. The most detailed are Practitioner (79 properties), Provider (72 properties), Affiliation (60 properties), InteriorBuilding (45 properties). Each schema is shown below with its type and property counts.

ACAEligibility
object
8 properties
ADA
object
4 properties
ADAIndicator
object
14 properties
Accreditation
object
7 properties
Accreditations
object
6 properties
AdditionalAddresses
object
15 properties
Address
object
18 properties
AdvancedMedicalHomeTier
object
5 properties
Affiliation
object
60 properties
Agreement
object
10 properties
AlternateName
object
3 properties
AmisysGroupRecord
object
2 properties
AmisysInfo
object
2 properties
AmisysProviderRecord
object
2 properties
AscensionOwnership
object
5 properties
Assessment
object
6 properties
Attributes
object
3 properties
Audit
object
2 properties
BillingPhoneNumbers
object
7 properties
BusinessEntityAffiliations
object
4 properties
BusinessIdentifiers
object
2 properties
CAPrisonCred
object
7 properties
CAPrisonSubSpecialties
object
6 properties
CAQH
object
12 properties
CBAS
object
1 property
CCSCertificate
object
4 properties
CDS
object
3 properties
CHDPCertificate
object
4 properties
CLIAAccreditation
object
1 property
CaveatMessages
object
2 properties
Certification
object
5 properties
CertificationIssue
object
9 properties
ClinicallyIntegratedNetworks
object
5 properties
CompPerinatalServiceProgram
object
4 properties
Contact
object
4 properties
Contract
object
14 properties
Credential
object
15 properties
CredentialingCycleInformation
object
6 properties
CulturalCompetenceTraining
object
9 properties
DEAInformation
object
3 properties
DirectoryDisplay
object
3 properties
DisclosureOfOwnership
object
8 properties
Domain
object
2 properties
ECFMG
object
4 properties
ECMAssignmentType
object
2 properties
EHR
object
9 properties
Education
object
10 properties
EligibleForDisplay
object
7 properties
EssentialCommunityProviderTypes
object
7 properties
EssentialCommunityProviderTypesProvLoc
object
7 properties
EssentialProviderIndicator
object
2 properties
EthnicMinorityRaceStatus
object
3 properties
ExtenderInformation
object
6 properties
ExteriorBuilding
object
13 properties
GeoCoords
object
3 properties
GeoJSONPoint
object
2 properties
HCBS
object
3 properties
HCBSAccreditation
object
4 properties
HIVAIDS
object
2 properties
HealthHomeIds
object
4 properties
Hospital
object
4 properties
HospitalPrivilege
object
5 properties
IndependentPhysicianAssociation
object
3 properties
IndianHealthCareProvider
object
4 properties
Insurance
object
8 properties
InteriorBuilding
object
45 properties
LegacyIds
object
4 properties
License
object
5 properties
LicensedBed
object
4 properties
LicensedBeds
object
1 property
Location
object
38 properties
LocationProvider
object
10 properties
MMAPhysicianIncentive
object
3 properties
Malpractice
object
17 properties
MasterProviderKeys
object
5 properties
MedicaidInfo
object
4 properties
MedicalHome
object
23 properties
MedicalLicense
object
6 properties
MedicareAdvantage
object
8 properties
MedicareAdvantageRequired
object
7 properties
MedicareClaimsOptOuts
object
3 properties
MessageHeader4
object
7 properties
Metadata
object
3 properties
NCAdvancedMedicaidHomeClinicallyIntegratedNetworkDataSharing
object
4 properties
NPI
object
5 properties
NationalId
object
2 properties
Network
object
9 properties
NetworkComponent
object
3 properties
NetworkCycle
object
9 properties
NetworkLocationAttributes
object
4 properties
NetworkResponse
object
2 properties
NetworkTermReasons
object
3 properties
OBGYN
object
2 properties
OMHIDHCBSID
object
3 properties
OPCert
object
3 properties
OfficeHourComponent
object
3 properties
OfficeHours
object
10 properties
OneCareKansas
object
6 properties
OtherLicenseCertification
object
6 properties
PPECCsk
object
2 properties
PPG
object
5 properties
PPGPanelStatuses
object
4 properties
PPGRiskTypes
object
3 properties
Panel
object
15 properties
PanelQuestion
object
5 properties
Parking
object
6 properties
PersonalProfile
object
4 properties
PharmacyService
object
3 properties
Phone
object
6 properties
PhoneNumber
object
7 properties
PhoneNumbers
object
7 properties
PnlcTerminationReason
object
3 properties
PracNetLocSpecialties
object
2 properties
PracPrisonIndicator
object
6 properties
Practitioner
object
79 properties
PractitionerLocation
object
35 properties
PractitionerResponse
object
2 properties
PractitionerSingleResponse
object
1 property
PractitionerTaxonomy
object
2 properties
ProfessionalProfile
object
4 properties
ProgramEnrollment
object
5 properties
ProgrammaticAccess
object
7 properties
ProvNetLocSpecialties
object
2 properties
ProvPrisonIndicator
object
6 properties
Provider
object
72 properties
ProviderCommunitySupports
object
4 properties
ProviderEnhancedCareManagement
object
4 properties
ProviderInMedicaidLocation
object
2 properties
ProviderKansasIdentifiers
object
15 properties
ProviderLocation
object
40 properties
ProviderLocationLegacy
object
4 properties
ProviderLocationTelemedicine
object
2 properties
ProviderLocationTinDetail
object
11 properties
ProviderRelationships
object
7 properties
ProviderResponse
object
2 properties
ProviderSingleResponse
object
1 property
ProviderSpecialty
object
3 properties
ProviderType
object
7 properties
QualityRating
object
2 properties
ResilienceIntegratedSystemsExcellence
object
4 properties
Response
object
2 properties
Service
object
3 properties
Specialties
object
3 properties
Specialty
object
14 properties
Taxonomies
object
3 properties
Taxonomy
object
5 properties
Termination
object
3 properties
VFCProgram
object
3 properties
VendorInformation
object
3 properties
healthResponse
object
Health response containing the status of the mongo database
3 properties
versionResponse
object
Version response containing build information of the current api
3 properties

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

centene-provider-rtr-demographics-openapi.json Raw ↑

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Centene Provider Carrier Entity Search (PCES) Extract API
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Centene Provider Search Suggest API
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#Provider#Demographics#Credentialing#Payer
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API Details
ID
centene:centene-provider-rtr-demographics
Base URL
https://api-gateway-01.centene.com/provider-rtr/demographics/
Docs
https://partners.centene.com/apiDetail/fa62cad4-34be-4b39-b599-30d8a8b7163b
Provider
Centene
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