This issue arose in the development of the Plan-Net (Provider Directory) IG – http://hl7.org/fhir/us/davinci-pdex-plan-net/ whose purpose is to define a FHIR interface to a health insurer’s insurance plans, their associated networks, and the organizations and providers that participate in these networks.

USCorePractitionerRole.organization is constrained to 1..1 (in R4, it is 0..1).

An individual practitioner with an LLC  does not have an organization with an NPI.  In payer provider directories, they will not have an associated organization.  As such, the PractitionerRole will associate the practitioner to a healthcareservice, location, specialty, etc, but not to an organization.

In Plan-Net, PractitionerRole.organization is constrained to 0..1 (as per R4), and an invariant is added requiring that at least one of organization, practitioner, healthcareservice, or location be provided.