WellCare FHIR Provider Directory API

openapi: 3.1.0
info:
  title: WellCare FHIR Provider Directory API
  description: >-
    The WellCare FHIR Provider Directory API provides access to up-to-date
    provider directory information, enabling third-party applications to query
    in-network physicians, specialists, hospitals, and other healthcare
    providers. The API follows HL7 FHIR R4 standards and the Da Vinci Provider
    Directory implementation guide (PDex Plan-Net), supporting CMS
    interoperability requirements for Medicaid and Medicare Advantage plans.
    Access is managed through the Centene Partner Portal at
    partners.centene.com/apis.
  version: '1.0'
  contact:
    url: https://www.wellcare.com/en/interoperability-and-patient-access
servers:
  - url: https://partners.centene.com
tags:
  - name: Practitioner
    description: Individual healthcare practitioners and clinicians.
  - name: Organization
    description: Healthcare organizations, hospitals, and facilities.
  - name: Location
    description: Physical care delivery locations and addresses.
  - name: Practitioner Role
    description: A practitioner's role within an organization and network.
  - name: Healthcare Service
    description: Services and specialties offered at locations.
  - name: Insurance Plan
    description: Insurance plan details including networks and coverage areas.
paths:
  /fhir/r4/Practitioner:
    get:
      operationId: searchPractitioners
      summary: Search Practitioners
      description: >-
        Searches for healthcare practitioners in the WellCare provider directory
        by name, specialty, NPI, or location. Returns practitioner demographic
        information, credentials, and specialties.
      tags:
        - Practitioner
      parameters:
        - name: name
          in: query
          description: Practitioner name (partial match supported).
          schema:
            type: string
        - name: identifier
          in: query
          description: NPI or other practitioner identifier.
          schema:
            type: string
        - name: specialty
          in: query
          description: NUCC taxonomy code or specialty name.
          schema:
            type: string
        - name: _count
          in: query
          description: Number of results per page.
          schema:
            type: integer
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Bundle of Practitioner resources returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
  /fhir/r4/Practitioner/{id}:
    get:
      operationId: getPractitioner
      summary: Get Practitioner
      description: >-
        Retrieves a specific practitioner resource by FHIR ID, returning
        full demographic and credential information.
      tags:
        - Practitioner
      parameters:
        - name: id
          in: path
          description: The FHIR Practitioner resource ID.
          required: true
          schema:
            type: string
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Practitioner resource returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Practitioner'
        '404':
          description: Practitioner not found.
  /fhir/r4/Organization:
    get:
      operationId: searchOrganizations
      summary: Search Organizations
      description: >-
        Searches for healthcare organizations, hospitals, clinics, and
        facilities in the WellCare provider network by name, type, or NPI.
      tags:
        - Organization
      parameters:
        - name: name
          in: query
          description: Organization name (partial match supported).
          schema:
            type: string
        - name: identifier
          in: query
          description: NPI or other organization identifier.
          schema:
            type: string
        - name: type
          in: query
          description: Organization type (e.g., hospital, clinic, pharmacy).
          schema:
            type: string
        - name: _count
          in: query
          description: Number of results per page.
          schema:
            type: integer
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Bundle of Organization resources returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
  /fhir/r4/Organization/{id}:
    get:
      operationId: getOrganization
      summary: Get Organization
      description: >-
        Retrieves a specific organization resource by FHIR ID.
      tags:
        - Organization
      parameters:
        - name: id
          in: path
          description: The FHIR Organization resource ID.
          required: true
          schema:
            type: string
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Organization resource returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Organization'
        '404':
          description: Organization not found.
  /fhir/r4/Location:
    get:
      operationId: searchLocations
      summary: Search Locations
      description: >-
        Searches for care delivery locations by address, ZIP code, or proximity
        to a given coordinate. Returns location details, hours, accessibility,
        and available services.
      tags:
        - Location
      parameters:
        - name: address-postalcode
          in: query
          description: ZIP code for location search.
          schema:
            type: string
        - name: near
          in: query
          description: Coordinate-based proximity search (latitude|longitude|distance|units).
          schema:
            type: string
        - name: _count
          in: query
          description: Number of results per page.
          schema:
            type: integer
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Bundle of Location resources returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
  /fhir/r4/PractitionerRole:
    get:
      operationId: searchPractitionerRoles
      summary: Search Practitioner Roles
      description: >-
        Searches for practitioner roles defining a practitioner's relationship
        with a healthcare organization and network, including specialties,
        accepted insurance plans, and care location affiliations.
      tags:
        - Practitioner Role
      parameters:
        - name: practitioner
          in: query
          description: FHIR Practitioner ID.
          schema:
            type: string
        - name: organization
          in: query
          description: FHIR Organization ID.
          schema:
            type: string
        - name: specialty
          in: query
          description: Specialty taxonomy code.
          schema:
            type: string
        - name: location
          in: query
          description: FHIR Location ID.
          schema:
            type: string
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Bundle of PractitionerRole resources returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
  /fhir/r4/InsurancePlan:
    get:
      operationId: searchInsurancePlans
      summary: Search Insurance Plans
      description: >-
        Retrieves WellCare insurance plan details including plan types,
        network coverage areas, benefit categories, and cost-sharing
        information for Medicaid and Medicare Advantage plans.
      tags:
        - Insurance Plan
      parameters:
        - name: name
          in: query
          description: Insurance plan name.
          schema:
            type: string
        - name: type
          in: query
          description: Plan type (e.g., HMO, PPO, SNP).
          schema:
            type: string
      security:
        - bearerAuth: []
      responses:
        '200':
          description: Bundle of InsurancePlan resources returned.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
components:
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: Bearer token from Centene Partner Portal OAuth 2.0 authorization.
  schemas:
    Bundle:
      type: object
      description: A FHIR Bundle resource containing a collection of resources.
      properties:
        resourceType:
          type: string
          example: Bundle
        id:
          type: string
        type:
          type: string
          enum: [searchset, collection]
        total:
          type: integer
        link:
          type: array
          items:
            type: object
            properties:
              relation:
                type: string
              url:
                type: string
        entry:
          type: array
          items:
            type: object
            properties:
              fullUrl:
                type: string
              resource:
                type: object
    Practitioner:
      type: object
      description: A FHIR Practitioner resource representing a healthcare clinician.
      properties:
        resourceType:
          type: string
          example: Practitioner
        id:
          type: string
        identifier:
          type: array
          items:
            type: object
            properties:
              system:
                type: string
              value:
                type: string
        name:
          type: array
          items:
            type: object
            properties:
              family:
                type: string
              given:
                type: array
                items:
                  type: string
        qualification:
          type: array
          items:
            type: object
    Organization:
      type: object
      description: A FHIR Organization resource representing a healthcare organization.
      properties:
        resourceType:
          type: string
          example: Organization
        id:
          type: string
        name:
          type: string
        type:
          type: array
          items:
            type: object
        address:
          type: array
          items:
            type: object
        telecom:
          type: array
          items:
            type: object