{ "slug": "role-gap-composition", "title": "What the role gap is made of", "hypotheses": [ "H54" ], "status": "published", "release_date": "2026-08-20", "generated_at": "2026-08-21T10:38:48.471447+00:00", "methodology_version": "0.7.2-draft", "commit_sha": "95feac2746c0a287ddfd87efa52914e382f97d4d", "headline": "NDH role coverage tracks Medicare billing, not clinical practice: 82.0% of PA advanced practice providers carry a PractitionerRole against 4.2% of pharmacy providers (526 of 12,465).", "numerator": 526, "denominator": 12465, "chart": { "type": "bar", "unit": "percent", "data": [ { "label": "advanced practice", "value": 82.0 }, { "label": "physician", "value": 74.3 }, { "label": "podiatry", "value": 69.3 }, { "label": "eye vision", "value": 67.7 }, { "label": "chiropractic", "value": 46.2 }, { "label": "student", "value": 27.4 }, { "label": "rehab therapy", "value": 24.6 }, { "label": "dietary", "value": 24.1 }, { "label": "other clinical", "value": 23.8 }, { "label": "behavioral health", "value": 22.9 }, { "label": "dental", "value": 13.3 }, { "label": "support", "value": 7.8 }, { "label": "nursing", "value": 4.8 }, { "label": "pharmacy", "value": 4.2 } ] }, "notes": "The registered prior was that the role gap is mostly NPIs that hold no patient record. It is not supported: categories that are not an independently practising clinician total 11,704 of 230,837 (5.1%), so removing them moves coverage by about a point. The measured signal is the spread between professions instead. Categories are NUCC groupings mapped one-to-one, which is a lookup rather than a judgement about any provider; no category is asserted to be incapable of holding a record. Rates are shown only for categories of at least 1,000 NPIs, because a three-member category would otherwise top the ranking. NPPES is joined unfiltered because BigQuery bills for columns read rather than rows returned, so a state predicate costs the same and drops practitioners whose NPPES practice address is out of state. Per-NPI detail ships as role-gap-composition-.csv.", "states": { "PA": { "state": "PA", "active_practitioners": 230837, "with_ndh_role": 100918, "with_ndh_role_pct": 43.7, "with_cms_enrollment_org_only": 1219, "affiliated_any_source": 102137, "affiliated_any_source_pct": 44.2, "no_organization_any_source": 128700, "cms_enrollment_crosswalk_present": true, "nppes_matched": 225184, "nppes_deactivated_but_ndh_active": 493, "non_clinical_categories": [ "student", "support", "transport", "supplier", "agency", "facility", "payer", "group" ], "non_clinical_npis": 11704, "non_clinical_npis_pct": 5.1, "non_clinical_unaffiliated": 8646, "unaffiliated_excluding_non_clinical": 120054, "clinical_denominator": 219133, "affiliated_pct_of_clinical_denominator": 45.2, "role_coverage_min_category_size": 1000, "role_coverage_by_category": [ { "category": "advanced-practice", "with_role": 28731, "total": 35032, "pct": 82.0 }, { "category": "physician", "with_role": 43003, "total": 57908, "pct": 74.3 }, { "category": "podiatry", "with_role": 973, "total": 1404, "pct": 69.3 }, { "category": "eye-vision", "with_role": 1932, "total": 2855, "pct": 67.7 }, { "category": "chiropractic", "with_role": 1696, "total": 3668, "pct": 46.2 }, { "category": "student", "with_role": 2661, "total": 9718, "pct": 27.4 }, { "category": "rehab-therapy", "with_role": 7966, "total": 32365, "pct": 24.6 }, { "category": "dietary", "with_role": 597, "total": 2473, "pct": 24.1 }, { "category": "other-clinical", "with_role": 1120, "total": 4708, "pct": 23.8 }, { "category": "behavioral-health", "with_role": 9756, "total": 42572, "pct": 22.9 }, { "category": "dental", "with_role": 1215, "total": 9155, "pct": 13.3 }, { "category": "support", "with_role": 105, "total": 1348, "pct": 7.8 }, { "category": "nursing", "with_role": 421, "total": 8830, "pct": 4.8 }, { "category": "pharmacy", "with_role": 526, "total": 12465, "pct": 4.2 } ], "role_coverage_spread": { "highest": { "category": "advanced-practice", "pct": 82.0 }, "lowest": { "category": "pharmacy", "pct": 4.2 } }, "by_category": [ { "category": "physician", "total": 57908, "with_role": 43003, "pecos_only": 162, "none": 14743, "deactivated": 171, "unaffiliated_pct_of_category": 25.5 }, { "category": "behavioral-health", "total": 42572, "with_role": 9756, "pecos_only": 310, "none": 32506, "deactivated": 85, "unaffiliated_pct_of_category": 76.4 }, { "category": "advanced-practice", "total": 35032, "with_role": 28731, "pecos_only": 169, "none": 6132, "deactivated": 40, "unaffiliated_pct_of_category": 17.5 }, { "category": "rehab-therapy", "total": 32365, "with_role": 7966, "pecos_only": 116, "none": 24283, "deactivated": 33, "unaffiliated_pct_of_category": 75.0 }, { "category": "pharmacy", "total": 12465, "with_role": 526, "pecos_only": 0, "none": 11939, "deactivated": 5, "unaffiliated_pct_of_category": 95.8 }, { "category": "student", "total": 9718, "with_role": 2661, "pecos_only": 155, "none": 6902, "deactivated": 79, "unaffiliated_pct_of_category": 71.0 }, { "category": "dental", "total": 9155, "with_role": 1215, "pecos_only": 13, "none": 7927, "deactivated": 11, "unaffiliated_pct_of_category": 86.6 }, { "category": "nursing", "total": 8830, "with_role": 421, "pecos_only": 39, "none": 8370, "deactivated": 2, "unaffiliated_pct_of_category": 94.8 }, { "category": "not-in-nppes", "total": 5653, "with_role": 74, "pecos_only": 189, "none": 5390, "deactivated": 0, "unaffiliated_pct_of_category": 95.3 }, { "category": "other-clinical", "total": 4708, "with_role": 1120, "pecos_only": 2, "none": 3586, "deactivated": 14, "unaffiliated_pct_of_category": 76.2 }, { "category": "chiropractic", "total": 3668, "with_role": 1696, "pecos_only": 24, "none": 1948, "deactivated": 15, "unaffiliated_pct_of_category": 53.1 }, { "category": "eye-vision", "total": 2855, "with_role": 1932, "pecos_only": 16, "none": 907, "deactivated": 13, "unaffiliated_pct_of_category": 31.8 }, { "category": "dietary", "total": 2473, "with_role": 597, "pecos_only": 16, "none": 1860, "deactivated": 3, "unaffiliated_pct_of_category": 75.2 }, { "category": "podiatry", "total": 1404, "with_role": 973, "pecos_only": 8, "none": 423, "deactivated": 9, "unaffiliated_pct_of_category": 30.1 }, { "category": "support", "total": 1348, "with_role": 105, "pecos_only": 0, "none": 1243, "deactivated": 0, "unaffiliated_pct_of_category": 92.2 }, { "category": "agency", "total": 258, "with_role": 71, "pecos_only": 0, "none": 187, "deactivated": 0, "unaffiliated_pct_of_category": 72.5 }, { "category": "facility", "total": 231, "with_role": 33, "pecos_only": 0, "none": 198, "deactivated": 1, "unaffiliated_pct_of_category": 85.7 }, { "category": "supplier", "total": 124, "with_role": 27, "pecos_only": 0, "none": 97, "deactivated": 0, "unaffiliated_pct_of_category": 78.2 }, { "category": "emergency-medical", "total": 34, "with_role": 3, "pecos_only": 0, "none": 31, "deactivated": 0, "unaffiliated_pct_of_category": 91.2 }, { "category": "transport", "total": 20, "with_role": 5, "pecos_only": 0, "none": 15, "deactivated": 1, "unaffiliated_pct_of_category": 75.0 }, { "category": "no-taxonomy", "total": 11, "with_role": 2, "pecos_only": 0, "none": 9, "deactivated": 11, "unaffiliated_pct_of_category": 81.8 }, { "category": "payer", "total": 5, "with_role": 1, "pecos_only": 0, "none": 4, "deactivated": 0, "unaffiliated_pct_of_category": 80.0 } ] } } }