This section explains Provider 360, a powerful solution within LakeFusion designed to create a unified, real-time view of healthcare providers. It addresses the fragmentation of provider data across systems—improving operational performance, compliance, and decision-making across the healthcare ecosystem.

What is Provider 360?

Provider 360 is a comprehensive data unification framework built on Databricks Lakehouse that harmonizes provider data across credentialing, claims, and operational systems. It ensures accurate and timely information about healthcare providers, which is critical for:

• Regulatory compliance (e.g., CMS, HIPAA)

• Credentialing verification

• Efficient scheduling and network management

• Accurate claims processing and reporting

By unifying these disparate records, LakeFusion enables a reliable and scalable foundation for Provider Master Data Management (MDM).

Sources Integrated

Provider 360 ingests and integrates structured and semi-structured data from multiple healthcare data platforms, including:

Each source contributes crucial pieces of provider data—ranging from qualifications and affiliations to claims history and operational touchpoints.

Use Case: From Fragmented Records to a Golden Record

🔹 Source Records (Pre-MDM)

Provider data is typically dispersed across siloed systems, with inconsistencies in formatting and naming conventions. For example:

• Credentialing System: Name: Dr. Alice Cooper, NPI: 1234567890

• Claims System: Name: A. Cooper, NPI: 1234567890

• Practice Management System: Name: Alice C., NPI: 1234567890

These fragmented records refer to the same individual but differ in naming conventions and completeness.

Consolidated Entity Creation

LakeFusion consolidates these fragmented records by identifying shared identifiers such as:

• NPI

• Name

• Specialty

The system groups related records—even when identifiers are inconsistently recorded—into a single provider entity.

Match Records

The Match Maven module combines semantic intelligence and business logic to link related provider records:

LLM Vector Search

• Identifies nuanced relationships across datasets.

• Example: Recognizes “Alice Cooper”, “A. Cooper”, and “Alice C.” as the same provider.

Custom Matching Rules

• Match using exact fields like:

  • NPI

  • Medical Specialty

  • Affiliated Facilities

Survivorship Rules

To resolve conflicting data across systems, Provider 360 uses configurable survivorship logic:

Priority-Based Strategy

• Trust hierarchy example:

  • NPI Registry > Credentialing System > Claims System

Recency-Based Strategy

• Selects the most recent or active:

  • Board Certification

  • Mailing Address

  • Practice Affiliation

Merged Golden Record

The final Golden Record serves as the single source of truth for the provider:

• Name: Dr. Alice Cooper

• NPI: 1234567890

• Affiliation: Midtown Health Group

This record is ready to be consumed by downstream systems for operations, analytics, and regulatory reporting.

Bronze, Silver, and Gold Data Tiers

Provider 360 aligns with the Medallion Architecture for structured data processing and consumption:

This tiered architecture ensures data transparency, reusability, and performance across the provider lifecycle.