Medicare NPI Physician And Other Supplier Payment Aggregate Report

$395 / year

The dataset contains information on utilization and payments (Total submitted charges, Medicare allowed amount, Medicare Payment amount, Medicare standardized payment amount) organized by National Provider Identity. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores. NPI Physician And Other Supplier Payment Aggregate Report from 2012 to 2015 is merged here.

Complexity

The Physician and Other Supplier Public Use File contains information on utilization, payment (Total submitted charges, Medicare allowed amount, Medicare Payment amount, Medicare standardized payment amount) organized by National Provider Identifier (NPI)and Healthcare Common Procedure Coding System (HCPCS) code. The data in the Physician and Other Supplier PUF is from physician/supplier Part B non-institutional line items for the Medicare fee-for-service (FFS) population. Claims processed by Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS) Medicare Administrative Contractor (MAC) are not included in the Physician and Other Supplier PUF. The 2015 data are available from the Centres for Medicaid and Medicare Services (CMS) Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For all Physician and Other Supplier PUF data years, provider demographics (name, credentials, gender, complete address and entity type) are taken from the National Plan & Provider Enumeration System (NPPES). CMS developed the NPPES to assign unique identifiers, known as National Provider Identifiers (NPIs), to health care providers. The demographic information provided in the 2015 Physician and Other Supplier PUF was extracted from NPPES at the end of the calendar year 2015.

The spending and utilization data in the Physician and Other Supplier PUF are aggregated to the following:
a) the NPI for the performing provider,
b) the Healthcare Common Procedure Coding System (HCPCS) code, and
c) the place of service (either facility or non-facility).

There can be multiple records for a given NPI based on the number of distinct HCPCS codes that were billed and where the services were provided. Data have been aggregated based on the place of service because separate fee schedules apply depending on whether the place of service submitted on the claim is facility or non-facility. The Physician and Other Supplier PUF and the supplemental summary tables including the “Medicare Physician and Other Supplier Aggregate Table” (i.e., one record per NPI) have been updated to include Medicare standardized payment amounts. The “Medicare Physician and Other Supplier Aggregate Table” (i.e., one record per NPI) have the Average beneficiary risk scores which provide information on the health status of the beneficiaries the providers serve.

Date Created

2017-02-15

Last Modified

2017-09-22

Version

2017-09-22

Update Frequency

Annual

Temporal Coverage

2012-2015

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare And Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

National Provider Identity, Aggregate Report, Medical Type Services, Drug Type Services, Utilization and Payment Data, Demographic and Health Characteristics, Medicare and Medicaid Entitlement, Chronic Conditions, Average Risk Scores

Other Titles

Medicare Physicians and Other Suppliers Utilization And Payment Data Aggregate Report, Medicare Beneficiaries Utilization, Payment And Charges Physician and Other Suppliers Aggregate Report, Medicare Physicians and Other Suppliers Utilization, Payment Data Demographic And Health Characteristics Aggregate Report, Medicare and Medicaid Entitlement, Physicians and Other Suppliers data, Chronic Conditions And Risk scores Aggregate Report

NameDescriptionTypeConstraints
YearYear of NPI aggregate informationdate-
National_Provider_IdentifierNational Provider Identifier (NPI) for the performing provider on the claim. The provider NPI is the numeric identifier registered in NPPES.integerlevel : Nominal
Last_Name_Of_The_Provider_Or_OrganizationWhen the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s last name. When the provider is registered as an organization (entity type code = ‘O’), this is the organization name.string-
First_Name_Of_The_ProviderWhen the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s first name. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.string-
Middle_Initial_Of_The_ProviderWhen the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s middle initial. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.string-
Credentials_Of_The_ProviderWhen the provider is registered in NPPES as an individual (entity type code=’I’), these are the provider’s credentials. When the provider is registered as an organization (entity type code = ‘O’), this will be blankstring-
Gender_Of_The_ProviderWhen the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s gender. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.string-
Entity_Type_Of_The_ProviderType of entity reported in NPPES. An entity code of ‘I’ identifies providers registered as individuals and an entity type code of ‘O’ identifies providers registered as organizations.string-
Street_Address_1_Of_The_ProviderThe first line of the provider’s street address, as reported in NPPES.string-
Street_Address_2_Of_The_ProviderThe second line of the provider’s street address, as reported in NPPES.string-
City_Of_The_ProviderThe city where the provider is located, as reported in NPPES. The ARMY areas were divided into three Military "States": AA - Armed Forces Americas, AE - Armed Forces Europe, AP - Armed Forces Pacific. Those States are divided into three "Cities": APO - Army Post Office, FPO - Fleet Post Office, DPO - Diplomatic Post Officestring-
Zip_Code_Of_The_ProviderThe provider’s zip code, as reported in NPPES.string-
State_Code_Of_The_ProviderThe state where the provider is located, as reported in NPPES. The fifty U.S. states and the District of Columbia are reported by the state postal abbreviation.string-
Country_Code_Of_The_ProviderThe country where the provider is located, as reported in NPPES. The country code will be ‘US’ for any state or U.S. possession.string-
Specialty_Type_Of_The_ProviderDerived from the provider specialty code reported on the claim. For providers that reported more than one specialty code on their claims, this is the specialty code associated with the largest number of services.string-
Is_Medicare_Participation_IndicatorIdentifies whether the provider participates in Medicare and/or accepts assignment of Medicare allowed amounts. The value will be ‘true’ for any provider that had at least one claim identifying the provider as participating in Medicare or accepting assignment of Medicare allowed amounts within HCPCS code and place of service. A non-participating provider may elect to accept Medicare allowed amounts for some services and not accept Medicare allowed amounts for other services.boolean-
Number_Of_HCPCSTotal number of unique HCPCS codes.integerlevel : Ratio
Number_Of_ServicesTotal provider services.numberlevel : Ratio
Number_Of_Medicare_BeneficiariesTotal Medicare beneficiaries receiving the provider services. The beneficiary counts reported in the demographic sub-groups (i.e., age, sex, race and entitlement) may not aggregate to the ‘Number of Unique Beneficiaries’ due to the suppression of beneficiaries fewer than 11 within the demographic sub-groups. In addition, a small percentage of beneficiaries are reflected in the “Number of Unique Beneficiaries” but are not reflected in the beneficiary demographic information due to the lack of demographic information available at the time of reporting.numberlevel : Ratio
Total_Submitted_Charge_AmountThe total charges that the provider submitted for all services.number-
Total_Medicare_Allowed_AmountThe Medicare allowed amount for all provider services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.number-
Total_Medicare_Payment_AmountTotal amount that Medicare paid after deductible and coinsurance amount have been deducted for all the provider's line-item services.number-
Total_Medicare_Standardized_Payment_AmountTotal amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item service and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care.number-
Drug_Suppress_IndicatorIdentifies whether the utilization, cost and payment information associated with HCPCS codes for drug services as listed on the Medicare Part B Drug Average Sales Price (ASP) list have been suppressed.string-
Number_Of_HCPCS_Associated_With_Drug_ServicesTotal number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP Fileintegerlevel : Ratio
Number_Of_Drug_ServicesTotal drug services, as defined from the Medicare Part B Drug ASP File.numberlevel : Ratio
Number_Of_Medicare_Beneficiaries_With_Drug_ServicesTotal Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.integerlevel : Ratio
Total_Drug_Submitted_Charge_AmountThe total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.number-
Total_Drug_Medicare_Allowed_AmountThe Medicare allowed amount for drug services, as defined from the Medicare Part B Drug ASP File. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.number-
Total_Drug_Medicare_Payment_AmountTotal amount that Medicare paid after deductible and coinsurance amount have been deducted for all the provider's line-item drug services, as defined from the Medicare Part B Drug ASP File.number-
Total_Drug_Medicare_Standardized_Payment_AmountTotal amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item drug service, as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied.number-
Medical_Suppress_IndicatorIdentifies whether the utilization, cost and payment information associated with HCPCS codes for Medical (non-ASP) services have been suppressed.string-
Number_Of_HCPCS_Associated_With_Medical_ServicesTotal number of HCPCS codes associated with medical (non-ASP) services.integerlevel : Ratio
Number_Of_Medical_ServicesTotal medical (non-ASP) services.numberlevel : Ratio
Number_Of_Medicare_Beneficiaries_With_Medical_ServicesTotal Medicare beneficiaries receiving medical (non-ASP) services.integerlevel : Ratio
Total_Medical_Submitted_Charge_AmountThe total charges that the provider submitted for medical (non-ASP) services.number-
Total_Medical_Medicare_Allowed_AmountThe Medicare allowed amount for medical (non-ASP) services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.number-
Total_Medical_Medicare_Payment_AmountTotal amount that Medicare paid after deductible and coinsurance amount have been deducted for all of the provider's line item medical (non-ASP) services.number-
Total_Medical_Medicare_Standardized_Payment_AmountTotal amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item medical (non-ASP) service, as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care.number-
Average_Age_Of_BeneficiariesAverage age of beneficiaries. Beneficiary age is calculated at the end of the calendar year or at the time of death.integerlevel : Ratio
Number_Of_Beneficiaries_Age_Less_65Number of beneficiaries under the age of 65. Beneficiary age is calculated at the end of the calendar year or at the time of death.integerlevel : Ratio
Number_Of_Beneficiaries_Age_65_To_74Number of beneficiaries between the ages of 65 and 74. Beneficiary age is calculated at the end of the calendar year or at the time of death.integerlevel : Ratio
Number_Of_Beneficiaries_Age_75_To_84Number of beneficiaries between the ages of 75 and 84. Beneficiary age is calculated at the end of the calendar year or at the time of death.integerlevel : Ratio
Number_Of_Beneficiaries_Age_Greater_Than_84Number of beneficiaries over the age of 84. Beneficiary age is calculated at the end of the calendar year or at the time of deathintegerlevel : Ratio
Number_Of_Female_BeneficiariesNumber of female beneficiariesintegerlevel : Ratio
Number_Of_Male_BeneficiariesNumber of male beneficiaries.integerlevel : Ratio
Number_Of_Non_Hispanic_White_BeneficiariesNumber of non-Hispanic white beneficiaries.integerlevel : Ratio
Number_Of_Black_Or_African_American_BeneficiariesNumber of non-Hispanic black or African American beneficiariesintegerlevel : Ratio
Number_Of_Asian_Pacific_Islander_BeneficiariesNumber of Asian Pacific Islander beneficiariesintegerlevel : Ratio
Number_Of_Hispanic_White_BeneficiariesNumber of Hispanic beneficiariesintegerlevel : Ratio
Number_Of_American_Indian_Alaska_Native_BeneficiariesNumber of American Indian or Alaska Native beneficiaries.integerlevel : Ratio
Number_Of_Beneficiaries_With_Race_Not_Elsewhere_ClassifiedNumber of beneficiaries with race not elsewhere classified.integerlevel : Ratio
Number_Of_Beneficiaries_With_Medicare_Only_EntitlementNumber of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar year.integerlevel : Ratio
Number_Of_Beneficiaries_With_Medicare_And_Medicaid_EntitlementNumber of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefits.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_Atrial_FibrillationPercent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation.integerlevel : Ratio
Percent_Of_Beneficiaries_With_Alzheimers_Disease_Or_DementiaPercent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_AsthmaPercent of beneficiaries meeting the CCW chronic condition algorithm for Asthma.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_CancerPercent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_Heart_FailurePercent of beneficiaries meeting the CCW chronic condition algorithm for heart failure.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_Chronic_Kidney_DiseasePercent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease.integerlevel : Ratio
Percent_Of_Beneficiaries_With_Chronic_Obstructive_Pulmonary_DiseasePercent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary diseaseintegerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_DepressionPercent of beneficiaries meeting the CCW chronic condition algorithm for depression.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_DiabetesPercent of beneficiaries meeting the CCW chronic condition algorithm for diabetes.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_HyperlipidemiaPercent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_HypertensionPercent of beneficiaries meeting the CCW chronic condition algorithm for hypertension.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_Ischemic_Heart_DiseasePercent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_OsteoporosisPercent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis.integerlevel : Ratio
Percent_Of_Beneficiaries_With_Rheumatoid_Arthritis_OsteoarthritisPercent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis.integerlevel : Ratio
Percent_Of_Beneficiaries_With_Schizophrenia_Other_Psychotic_DisordersPercent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders.integerlevel : Ratio
Percent_Of_Beneficiaries_Identified_With_StrokePercent of beneficiaries meeting the CCW chronic condition algorithm for stroke.integerlevel : Ratio
Average_HCC_Risk_Score_Of_BeneficiariesAverage Hierarchical Condition Category (HCC) risk score of beneficiaries. CMS developed a risk-adjustment model that uses HCCs (hierarchical condition categories) to assign risk scores. Those scores estimate how beneficiaries’ FFS spending will compare to the overall average for the entire Medicare population. The average risk score is set at 1.08; beneficiaries with scores greater than that are expected to have above-average spending, and vice versa. Risk scores are based on a beneficiary’s age and sex; whether the beneficiary is eligible for Medicaid, first qualified for Medicare on the basis of disability, or lives in an institution (usually a nursing home); and the beneficiary’s diagnoses from the previous year. The HCC model was designed for risk adjustment on larger populations, such as the enrollees in an MA plan, and generates more accurate results when used to compare groups of beneficiaries rather than individualsnumberlevel : Ratio
YearNational_Provider_IdentifierLast_Name_Of_The_Provider_Or_OrganizationFirst_Name_Of_The_ProviderMiddle_Initial_Of_The_ProviderCredentials_Of_The_ProviderGender_Of_The_ProviderEntity_Type_Of_The_ProviderStreet_Address_1_Of_The_ProviderStreet_Address_2_Of_The_ProviderCity_Of_The_ProviderZip_Code_Of_The_ProviderState_Code_Of_The_ProviderCountry_Code_Of_The_ProviderSpecialty_Type_Of_The_ProviderIs_Medicare_Participation_IndicatorNumber_Of_HCPCSNumber_Of_ServicesNumber_Of_Medicare_BeneficiariesTotal_Submitted_Charge_AmountTotal_Medicare_Allowed_AmountTotal_Medicare_Payment_AmountTotal_Medicare_Standardized_Payment_AmountDrug_Suppress_IndicatorNumber_Of_HCPCS_Associated_With_Drug_ServicesNumber_Of_Drug_ServicesNumber_Of_Medicare_Beneficiaries_With_Drug_ServicesTotal_Drug_Submitted_Charge_AmountTotal_Drug_Medicare_Allowed_AmountTotal_Drug_Medicare_Payment_AmountTotal_Drug_Medicare_Standardized_Payment_AmountMedical_Suppress_IndicatorNumber_Of_HCPCS_Associated_With_Medical_ServicesNumber_Of_Medical_ServicesNumber_Of_Medicare_Beneficiaries_With_Medical_ServicesTotal_Medical_Submitted_Charge_AmountTotal_Medical_Medicare_Allowed_AmountTotal_Medical_Medicare_Payment_AmountTotal_Medical_Medicare_Standardized_Payment_AmountAverage_Age_Of_BeneficiariesNumber_Of_Beneficiaries_Age_Less_65Number_Of_Beneficiaries_Age_65_To_74Number_Of_Beneficiaries_Age_75_To_84Number_Of_Beneficiaries_Age_Greater_Than_84Number_Of_Female_BeneficiariesNumber_Of_Male_BeneficiariesNumber_Of_Non_Hispanic_White_BeneficiariesNumber_Of_Black_Or_African_American_BeneficiariesNumber_Of_Asian_Pacific_Islander_BeneficiariesNumber_Of_Hispanic_White_BeneficiariesNumber_Of_American_Indian_Alaska_Native_BeneficiariesNumber_Of_Beneficiaries_With_Race_Not_Elsewhere_ClassifiedNumber_Of_Beneficiaries_With_Medicare_Only_EntitlementNumber_Of_Beneficiaries_With_Medicare_And_Medicaid_EntitlementPercent_Of_Beneficiaries_Identified_With_Atrial_FibrillationPercent_Of_Beneficiaries_With_Alzheimers_Disease_Or_DementiaPercent_Of_Beneficiaries_Identified_With_AsthmaPercent_Of_Beneficiaries_Identified_With_CancerPercent_Of_Beneficiaries_Identified_With_Heart_FailurePercent_Of_Beneficiaries_Identified_With_Chronic_Kidney_DiseasePercent_Of_Beneficiaries_With_Chronic_Obstructive_Pulmonary_DiseasePercent_Of_Beneficiaries_Identified_With_DepressionPercent_Of_Beneficiaries_Identified_With_DiabetesPercent_Of_Beneficiaries_Identified_With_HyperlipidemiaPercent_Of_Beneficiaries_Identified_With_HypertensionPercent_Of_Beneficiaries_Identified_With_Ischemic_Heart_DiseasePercent_Of_Beneficiaries_Identified_With_OsteoporosisPercent_Of_Beneficiaries_With_Rheumatoid_Arthritis_OsteoarthritisPercent_Of_Beneficiaries_With_Schizophrenia_Other_Psychotic_DisordersPercent_Of_Beneficiaries_Identified_With_StrokeAverage_HCC_Risk_Score_Of_Beneficiaries
20121992798193JACKSONJOHNMODMIndividual1225 MADISON AVEMEMPHIS38104TNUSOptometrytrue5121291591568451212915915684691.0119
20121215165022POTWINSTACYO.D.FIndividual1622 COMMONS DRGENEVA601342531ILUSOptometrytrue3121290090072031212900900720700.882
20131558361493DCRUZPAULIMDMIndividual7714 CONNER RDPOWELL378493559TNUSPsychiatrytrue124112407270.98124112407270.98501.0137
20121013939628LEESCOTTCODMIndividual87 MAIN STWELLSBORO16901PAUSOphthalmologytrue11715510510350.911715510510350.975150.9149
20121205031630NOURYPAULEODMIndividual73 S RIVER RDBEDFORD31106755NHUSOptometrytrue11111704704433.711111704704433.766111.283
20121336473198JITSIMRANMDFIndividual2750 11TH STROCK ISLAND612015216ILUSFamily Practicetrue115123754545115123754545611.1241
20151073871356HAMMONDJULIEAFIndividual27 MARROWS RDNEWARK197133701DEUSFamily Practicetrue41514528357.7350.53350.53#*660.9804
20121669786166WALSHMATTHEWO.D.MIndividual33 W 42ND STNEW YORK100368005NYUSOptometrytrue515156556554525151565565545268730.8723
20131013939628LEESCOTTCODMIndividual87 MAIN STWELLSBORO16901PAUSOphthalmologytrue12322890890646.412322890890646.47550641.0467
20121275529356LIMVICENTEMMDMIndividual301 COX STROSELLE72031703NJUSPsychiatrytrue1201310821082659.471201310821082659.47520.854