Definitions

A health care practitioner, licensed health care practitioner, licensed practitioner, or practitioner, as used in this Guidebook, is defined as an individual who is licensed or otherwise authorized by a state to provide health care services; or any individual who, without authority, holds himself or herself out to be so licensed or authorized. See Table C-1, parts 1 and 2.

A dentist is defined as a doctor of dental surgery, dental medicine, or the equivalent who is legally authorized to practice dentistry by a state, or any individual who, without authority, holds himself or herself out to be so authorized.

A physician is defined as a doctor of medicine or osteopathy legally authorized to practice medicine or surgery by a state, or any individual who, without authority, holds himself or herself out to be so authorized.

A health care entity means:

• A hospital
• An entity that provides health care services and engages in professional review activity through a formal peer review process for the purpose of furthering quality health care, or a committee of that entity, or
• A professional society, or a committee or agent thereof, including those at the national, state, or local level, of physicians, dentists, or other health care practitioners that engages in professional review activity through a formal peer review process for the purpose of furthering quality health care

For purposes of the second bullet of this definition, an entity includes a health maintenance organization (HMO) that is licensed by a state or determined to be qualified as such by the Department of Health and Human Services (HHS), and any group or prepaid medical or dental practice that meets the criteria of the second bullet.

A formal peer review process is the conduct of professional review activities through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing.

A health care provider means:

• A provider of services as defined in Section 1861(u) of the Social Security Act
• Any organization (including an HMO, preferred provider organization, or group medical practice) that provides health care services and follows a formal peer review process for the purpose of furthering quality health care, or
• Any other organization that, directly or through contracts, provides health care services

A health care supplier means:

• A provider of medical and other health care services as described in Section 1861(s) of the Social Security Act
• Any individual or entity, other than a provider, who furnishes, whether directly or indirectly, or provides access to, health care services, supplies, items, or ancillary services (including, but not limited to, durable medical equipment suppliers, manufacturers of health care items, pharmaceutical suppliers and manufacturers, health record services [such as medical, dental, and patient records], health data suppliers, and billing and transportation service suppliers)
• Any individual or entity under contract to provide such supplies, items, or ancillary services
• Health plans as defined in NPDB regulations (including employers that are self-insured), or
• Health insurance producers (including but not limited to agents, brokers, solicitors, consultants, and reinsurance intermediaries)

Table C-1 lists examples of health care practitioners. Table C-2 offers examples of health care entities, providers, and suppliers. Table C-3 provides a summary of reporting requirements and query access for the NPDB.