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NetworkSim queries real NPPES provider data (8.9M records), CMS facility data (60K+ facilities), and quality metrics. Unlike synthetic generation, it uses actual registered providers to enable:
Provider Discovery: Search by specialty, location, credentials, quality
Network Analysis: Assess adequacy against CMS MA, NCQA, Medicaid standards
Healthcare Access: Identify deserts via access gaps, health needs, vulnerability
Cross-Product Integration: Provide real providers for PatientSim, MemberSim, TrialSim
Quick Reference
I want to...
Use This Skill
Key Triggers
Provider Search
Find providers by specialty
query/provider-search.md
"find cardiologists", "search for PCPs", "providers in"
{"npi":"1234567890","entity_type":"individual","name":{"last":"Johnson","first":"Sarah","credential":"MD, FACC"},"taxonomy":{"code":"207RC0000X","classification":"Internal Medicine","specialization":"Cardiovascular Disease"},"practice_location":{"address":"123 Medical Center Dr","city":"Houston","state":"TX","zip":"77030","county_fips":"48201"},"enumeration_date":"2015-03-15","last_update":"2024-11-01"}
Star ratings (1-5), mortality, readmission, safety
network.physician_quality
CMS Physician Compare
1,478,309
Quality measures, Medicare participation
network.ahrf_county
HRSA AHRF
3,235
Provider counts, hospital beds, health workforce
Regulatory Standards
See reference/network-adequacy.md for full CMS MA ratios, time/distance tables, NCQA 13 essential specialties, ECP requirements, and HPSA/MUA definitions.
Quick reference:
CMS MA PCP ratio: 1:1,200 enrollees
HRSA HPSA threshold: <60 PCPs per 100K
NCQA requires coverage across 13 specialties
Time/distance varies by urban/suburban/rural designation
Database: healthsim.duckdb (1.7 GB), indexed on county_fips, taxonomy_1, practice_state
Cross-Product Integration
NetworkSim → PatientSim
Assign providers to clinical encounters:
-- Find cardiologist for heart failure patientSELECT npi, first_name, last_name, credential
FROM network.providers
WHERE taxonomy_1 LIKE'207RC%'-- CardiovascularAND practice_state ='TX'AND county_fips ='48201'-- Harris County
LIMIT 1;
NetworkSim → MemberSim
Determine network status for claims:
-- Check if provider is in networkSELECTCASEWHEN p.npi ISNOT NULLTHEN'IN_NETWORK'ELSE'OUT_OF_NETWORK'ENDas network_status
FROM network.providers p
WHERE p.npi ='1234567890';
NetworkSim + PopulationSim
Equity analysis combining provider access with vulnerability:
-- Provider access in vulnerable communitiesSELECT
sv.county,
sv.rpl_themes as svi_percentile,
COUNT(DISTINCT p.npi) as provider_count,
sv.e_totpop as population,
ROUND(COUNT(DISTINCT p.npi) *100000.0/ sv.e_totpop, 1) as per_100k
FROM population.svi_county sv
LEFTJOIN network.providers p ON sv.stcnty = p.county_fips
WHERE sv.rpl_themes >0.75-- Most vulnerable quartileGROUPBY sv.county, sv.rpl_themes, sv.e_totpop
ORDERBY per_100k ASC;
Safety Guardrails
Real Data Disclaimer
NetworkSim queries real NPPES registry data (public CMS data, non-PHI). Every NPI is a real registered provider. Results reflect registry status only -- not accepting-patients, insurance participation, or clinical competence.
What NetworkSim Does NOT Do
No clinical advice: Never suggest a provider is "best" for a condition
No insurance verification: Network status is simulated, not real-time eligibility
No appointment scheduling: Registry data is not a booking system
No synthetic NPIs in real queries: Use synthetic/ skills only for test data
Code System References
System
Used For
Example
NUCC Taxonomy
Provider specialty classification
207RC0000X = Cardiovascular Disease
NPI
Provider identification (Luhn-validated)
1234567890
County FIPS
Geographic scoping
48201 = Harris County, TX
CMS Certification Number
Facility identification
POS file facility IDs
CBSA
Urban/rural classification
Metro, micro, rural designations
HCPCS
Provider service codes
Level I (CPT) and Level II codes
Cross-product code systems (via PatientSim/MemberSim/RxMemberSim integration): ICD-10 (diagnoses), CPT (procedures), LOINC (labs), SNOMED (clinical terms), RxNorm/NDC (medications). These are real standard codes -- linked patient data is synthetic/fictional.
Edge Cases
Missing county_fips: ~2.2% of records lack county FIPS; filter with WHERE county_fips IS NOT NULL for geographic queries
Deactivated NPIs: Check npi_deactivation_date IS NULL for active providers
Multi-taxonomy providers: Up to 15 taxonomies; taxonomy_1 is primary but check taxonomy_2-taxonomy_4 for dual-specialty searches
Organization vs Individual: entity_type_code = 1 (individual) vs 2 (organization); filter appropriately
Negative Examples (What NOT to Do)
Never give clinical advice based on provider data:
WRONG: "I recommend Dr. Smith for your heart condition" or "The patient needs a cardiologist"
RIGHT: "Here are cardiologists registered in Harris County per NPPES data. This is simulated test data for analytics, not a referral."
Always distinguish real reference data from synthetic/fictional entities:
WRONG: "Here is the patient's real provider" (implies real clinical relationship)
RIGHT: "NPI data is from the real NPPES registry (public CMS data). Patient/encounter data is synthetic/fictional -- not real patient information."
Never mix synthetic and real data without labeling:
WRONG: Return synthetic NPIs alongside real NPPES query results
RIGHT: Label synthetic providers (from synthetic/ skills) vs real providers (from network.providers)
Validation Rules
NPI: 10 digits, Luhn checksum, prefix 1 (individual) or 2 (organization), active in NPPES
