# License Intelligence — Provider Licensing + Disciplinary Action Data

**Audience:** credentialing teams, compliance officers, healthcare risk underwriters, locum/staffing platforms, payer network adequacy reviewers.

**What this is.** A single API surface for current license status, multi-state license footprint, and federal-level disciplinary action history per NPI — built on public, citable sources.

## What's in v1 (shipped)

| Source | What it gives us | Coverage |
|---|---|---|
| NPPES taxonomy_license + taxonomy_state | State-issued license number for the provider's primary specialty enrollment, plus license type classification (MD/DO, PA/APRN, dental, podiatric, optometric, nursing, other) | ~5 M licensed providers across all 50 states |
| OIG LEIE (List of Excluded Individuals/Entities) | Federal-level disciplinary action: providers excluded from billing federal healthcare programs. Severity classified per LEIE authorities (mandatory exclusion = critical; permissive exclusion = high) | ~8.5 K NPI-linked actions; current active exclusions ≈ 5.4 K critical, 3.2 K high |

## API surface

| Endpoint | What it returns |
|---|---|
| `GET /licenses/state/{state_code}` | Per-state breakdown: licensed counts by type and status, plus 25 most-recent active disciplinary actions in the state |
| `GET /licenses/{npi}` | Per-NPI license summary across all states + disciplinary action counts by severity |
| `GET /licenses/{npi}/disciplinary` | Full disciplinary action history for an NPI |
| `GET /licenses/alerts/recent?days=90&severity_floor=high` | Cross-state alert feed: recent currently-active actions ≥ severity floor |
| `GET /provider/{npi}` | Existing dossier — now includes `license_intelligence` summary block |

## What's coming in Loop 3

Currently we surface the federal exclusion layer + state license registration. Loop 3 adds the state-by-state disciplinary action layer:

- **CA Medical Board public actions** — direct ingestion of CA Med Board's quarterly Action Report (probation, public reprimand, citation, fine actions that don't rise to LEIE level)
- **TX Medical Board, FL Department of Health, NY OPP** — same pattern for TX/FL/NY
- **DEA Registration Validation Service** — DEA registration status + business address for controlled-substance prescribers

After Loop 3 we'll have full state-level disciplinary detail for ~60% of US physicians (the four largest states by population). The rest will fill in as additional state board sources become available.

## Use cases

**Credentialing onboarding.** Pre-employment check: `GET /licenses/{npi}` returns license status + disciplinary summary in one call. Fail-closed logic: if `disciplinary_summary.currently_active_actions > 0`, flag for manual review.

**Ongoing compliance monitoring.** Daily cron: `GET /licenses/alerts/recent?days=1&severity_floor=high`. Returns yesterday's new high+critical actions. Feed your alerting system; trigger on NPIs in your employed-physician set.

**Network adequacy review (payer).** Per-state license counts let you size the addressable provider pool. Use with our Network Intelligence (Loop 2 — Healthcare.gov + MA) to compare in-network counts vs licensed pool.

**Staffing platform risk screening.** Locum tenens and gig-economy healthcare platforms need fast license validation. `GET /licenses/{npi}/disciplinary` gives full action history with public source URLs for due diligence.

**M&A diligence on physician groups.** Buyer wants to know the disciplinary profile of all docs at the target group. Combine `GET /systems/{system_id}/physicians` with `GET /licenses/{npi}/disciplinary` per NPI; aggregate to action rate per 1000 providers. Compare against peer groups.

## How this is different from Definitive Healthcare and Doximity

**Definitive Healthcare** publishes hospital + physician affiliation data; license status and disciplinary actions are not a first-class product surface. Their NPI-level data does not include LEIE matching as a structured field.

**Doximity** is a physician self-reported network. License data is whatever the physician enters into their profile. No structured disciplinary action surface.

**Our approach:** every record cites a public, stable source URL. Every record has a `source` field so customers can filter by data origin. Every alert response includes `is_currently_active` so downstream systems can distinguish between current open actions and resolved historical actions.

## Source provenance

Every license + disciplinary record returns:
- `source`: which dataset the row comes from (`nppes`, `oig_leie`, `ca_medical_board`, etc.)
- `source_url`: the public URL where the original record can be verified
- `raw_payload`: the original fields from the source, preserved as JSONB

Customers can audit any single claim back to its public origin. There is no proprietary "we cleaned it, trust us" layer between the public source and what the API returns.

## Limitations to disclose to buyers

1. **State-level disciplinary detail varies.** Loop 1 covers federal exclusions (LEIE) only. State board public reprimands, probations, and fines below the LEIE threshold are not captured until Loop 3 (CA first, then TX/FL/NY).
2. **License coverage is broad but flat.** NPPES gives us one license per NPI (the primary specialty's). Multi-state license holders are not fully captured in v1 — Loop 3 fills this in via direct state-board pulls.
3. **Action timing.** OIG LEIE is updated monthly; our snapshot reflects the last refresh. The `source_registry` endpoint shows `last_loaded_at` per source so customers know data freshness.

## Public sources cited

- CMS NPPES NPI Registry: https://npiregistry.cms.hhs.gov/
- HHS OIG LEIE: https://oig.hhs.gov/exclusions/exclusions_list.asp
- OIG Exclusion Authorities: https://oig.hhs.gov/exclusions/authorities.asp
- CA Medical Board (Loop 3 target): https://www.mbc.ca.gov/Resources/Statistics/Default.aspx
- DEA Registration Validation (Loop 3 target): https://www.deadiversion.usdoj.gov/

## Pricing implication

Sold as a tiered add-on to the core Provider Intelligence API. Suggested tiers:
- **Standard:** federal exclusions + NPPES license footprint (Loop 1 coverage) — included in base subscription.
- **Compliance Pro:** state board disciplinary feeds + DEA registration (Loop 3 coverage) — separate add-on, suitable for compliance and credentialing teams.
- **Real-time alerts:** webhook + email delivery of new high+critical actions (future) — premium add-on.