Utilization and Payment Data Physician and Other Supplier 2016

$716 / year

The dataset contains information on ‘Provider Utilization and Payment Data Physician and Other Supplier Public Use File (PUF)’ prepared by the Centers for Medicare & Medicaid Services (CMS) and organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System code, and place of service. This PUF is based on information from CMS’s National Claims History (NCH) Standard Analytic Files (SAFs).

Complexity

This dataset from CMS has information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The primary data source for this dataset is CMS’s National Claims History (NCH) Standard Analytic Files (SAFs). The Centers for Medicare and Medicaid Services (CMS) collects data from all hospitals that provide services to Medicare beneficiaries on an ongoing basis through its fiscal intermediaries, and compiles the data for each calendar year. The Physician/Supplier SAF was used to create the Physician and Other Supplier PUF, which includes services from physicians, non-physician practitioners, laboratories, imaging, ambulances, etc. The dataset contains information on utilization and payments (Average submitted charges, Average Medicare allowed amount, Average Medicare Payment amount, Medicare standardized payment amount) on NPI. The detailed information on Physicians, Number of services and Number of HCPCS handled by physicians are also included. The number of services, providers, unique beneficiaries, per day services on unique beneficiaries are included here. Average Medicare standardized amount included in 2016 dataset.

Date Created

2018-05-08

Last Modified

2018-05-23

Version

2018-05-23

Update Frequency

Annual

Temporal Coverage

2016

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Doctors, Medicare Claim, Physician Services, Medicare Physicians, Medicare Find a Doctor, Medicare Providers, National Claims History (NCH), Medicare Billing, Physician Services, Doctors Pay

Other Titles

Medicare Providers Utilization and Billing Payment Data for Physicians and Other Suppliers 2016, Prospective Payment System 2016, Doctor Utilization and Payment Data 2016, Medicare Doctors and Providers Utilization and Payment Data 2016, Medicare Billing and Providers Utilization and Payment Data for Physicians and Other Suppliers 2016, Doctors Pay and Medicare Providers Utilization and Payment Data 2016

NameDescriptionTypeConstraints
National_Provider_IdentifierNational Provider Identifier (NPI) for the performing provider on the claim.integerlevel : Nominal
Last_Name_Organization_Name_Of_The_ProviderLast Name or Organization Name of the Provider- When 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_ProviderFirst Name of the Provider: When 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_ProviderMiddle Initial of the Provider: When 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_ProviderCredentials of the Provider: When 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 blank.string-
Gender_Of_The_ProviderGender of the Provider: When 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_ProviderEntity Type of the Provider: Type 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_ProviderStreet Address 1 of the Provider: The first line of the provider’s street address, as reported in NPPES.string-
Street_Address_2_Of_The_ProviderStreet Address 2 of the Provider: The first line of the provider’s street address, as reported in NPPES.string-
CityCity of the Provider: The city where the provider is located, as reported in NPPES.string-
ZIP_CodeZip Code of the Provider: The provider’s zip code, as reported in NPPES.string-
State_AbbreviationState Code: The state where the provider is located, as reported in NPPES.string-
Country_CodeCountry Code: The country where the provider is located, as reported in NPPES.string-
Specialty_Type_Of_The_ProviderType of the Provider- Provider Type: Derived from the provider specialty code reported on the claim.string-
Is_Medicare_Participation_IndicatorMedicare Participation Indicator: Identifies whether the provider participates in Medicare and/or accepts assignment of Medicare allowed amounts.boolean-
Place_Of_ServicePlace of Service: Identifies whether the place of service submitted on the claims is a facility (value of ‘F’) or non-facility (value of ‘O’). Non-facility is generally an office setting; however other entities are included in non-facility. See “Appendix B – Place of Service Descriptions” for the types of entities included in facility and non-facility.string-
HCPCS_CodeHealthcare Common Procedure Coding System (HCPCS) Code: HCPCS code for the specific medical service furnished by the provider.string-
HCPCS_DescriptionHCPCS Description: Description of the HCPCS code for the specific medical service furnished by the provider.string-
Is_HCPCS_Drug_IndicatorHCPCS Drug Indicator as in the ASP Drug List: Identifies whether the HCPCS code for the specific service furnished by the provider is an HCPCS listed on the Medicare Part B Drug Average Sales Price (ASP) File.boolean-
Number_Of_ServicesNumber of services provided; note that the metrics used to count the number provided can vary from service to service.numberlevel : Ratio
Number_Of_Medicare_BeneficiariesNumber of distinct Medicare beneficiaries receiving the service.integerlevel : Ratio
Number_Of_Distinct_Medicare_Beneficiary_Per_Day_ServicesNumber of Distinct Medicare Beneficiary/Per Day Services- Since a given beneficiary may receive multiple services of the same type (e.g., single vs. multiple cardiac stents) on a single day, this metric removes double-counting from the line service count to identify whether a unique service occurred.integerlevel : Ratio
Average_Medicare_Allowed_AmountAverage of the Medicare allowed amount for the service; 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-
Average_Submitted_Charge_AmountAverage Submitted Charge Amount- Average of the charges that the provider submitted for the service.number-
Average_Medicare_Payment_AmountAverage Medicare Payment Amount- Average amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item service.number-
Average_Medicare_Standardized_AmountAverage Medicare Standardized Amount which is the average amount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for the line item service and after standardization of the Medicare payment has been applied.number-
National Provider IdentifierLast Name Organization Name Of The ProviderFirst 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 ProviderCityZIP CodeState AbbreviationCountry CodeSpecialty Type Of The ProviderIs Medicare Participation IndicatorPlace Of ServiceHCPCS CodeHCPCS DescriptionIs HCPCS Drug IndicatorNumber Of ServicesNumber Of Medicare BeneficiariesNumber Of Distinct Medicare Beneficiary Per Day ServicesAverage Medicare Allowed AmountAverage Submitted Charge AmountAverage Medicare Payment AmountAverage Medicare Standardized Amount
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99217Hospital observation care dischargeFalse57555772.743157895325.1578947454.47438596555.807192982
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99219Hospital observation care typically 50 minutesFalse383838135.01614.0105.85107.23
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99220Hospital observation care typically 70 minutes per dayFalse232323189.23956522769.34782609146.11652174144.27869565
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99221Initial hospital inpatient care, typically 30 minutes per dayFalse202020100.75460.078.9980.28
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99222Initial hospital inpatient care, typically 50 minutes per dayFalse968796136.25625.0105.47760417107.00770833
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99223Initial hospital inpatient care, typically 70 minutes per dayFalse148141148203.79391892920.61486486159.08344595159.59716216
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99225Subsequent observation care, typically 25 minutes per dayFalse11111172.48328.056.8257.54
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99232Subsequent hospital inpatient care, typically 25 minutes per dayFalse59627059671.864362416326.4865771856.21098993356.855134228
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99233Subsequent hospital inpatient care, typically 35 minutes per dayFalse11785117103.54470.080.90931623981.989230769
1003000126ENKESHAFIARDALANM.D.MI900 SETON DRCUMBERLAND215021854MDUSInternal MedicineTrueF99238Hospital discharge day management, 30 minutes or lessFalse20202072.12328.052.831553.561