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Identifying Endocrinology Nurse Practitioners and Physician Associates Using Claims Data.
Anya Cutler1, Dana Schwartz2, Chelsea Bodnar3
1Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research. 1, Riverfront Plaza, Westbrook, ME 04092, USA.
The Journal for Nurse Practitioners : JNP
|June 22, 2026
Summary
Medical claims data often miss care provided by Nurse Practitioners and Physician Associates. A high proportion of type 1 diabetes visits indicated endocrinology specialization for these providers in Montana.
Area of Science:
- Health Services Research
- Medical Informatics
- Pediatric Endocrinology
Background:
- Nurse Practitioners (NPs) and Physician Associates (PAs) are increasingly delivering pediatric specialty care.
- Current medical claims data may not accurately capture the specialized care provided by NPs and PAs due to limitations in taxonomy codes.
- This underrepresentation can skew healthcare workforce research and resource allocation.
Purpose of the Study:
- To investigate methods for identifying NP and PA specialization in pediatric endocrinology using existing medical claims data.
- To assess the reliability of using diagnosis codes in conjunction with provider type to infer specialization.
- To improve the accuracy of healthcare workforce research by accounting for NP and PA contributions.
Main Methods:
- Analysis of 2021 Montana Medicaid medical claims data.
- Inclusion of claims data associated with type 1 diabetes diagnoses.
- Correlation of claims data with phone-based surveys of 37 identified healthcare providers to validate specialization.
- Evaluation of the proportion of NP/PA visits for type 1 diabetes as an indicator of endocrinology expertise.
Main Results:
- A significant proportion of NP and PA visits linked to type 1 diabetes diagnoses reliably indicated specialization in endocrinology.
- The findings suggest that specific diagnostic patterns can serve as a proxy for NP and PA subspecialties.
- This method offers a potential solution to the undercounting of specialized NP and PA care in claims data.
Conclusions:
- Healthcare workforce research can be enhanced by utilizing diagnostic data to infer NP and PA specialization.
- A high volume of type 1 diabetes-related visits is a strong indicator of endocrinology expertise among NPs and PAs.
- Future research should incorporate these findings to more accurately represent the pediatric specialty care landscape.
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