Verify the accuracy of SSNs of all individual Medicare providers, owners, managing/directing employees, authorized representatives, ambulance service medical directors, ambulance crew members, technicians, chain organization administrators, Independent Diagnostic Test Facility (IDTF), supervising/directing physicians, and IDTF interpretation service providers. Also included in this Agreement are individual health care providers who apply for a National Provider Identification Number (NPI).

Context

The CMS National Plan and Provider Enumeration System (NPPES) was developed as part of the Administrative Simplification provisions in the original HIPAA act. The primary purpose of NPPES was to develop a unique identifier for each physician that billed medicare and medicaid. This identifier is now known as the National Provider Identifier Standard (NPI) which is a required 10 digit number that is unique to an individual provider at the national level.

Once an NPI record is assigned to a healthcare provider, parts of the NPI record that have public relevance, including the provider’s name, speciality, and practice address are published in a searchable website as well as downloadable file of zipped data containing all of the FOIA disclosable health care provider data in NPPES and a separate PDF file of code values which documents and lists the descriptions for all of the codes found in the data file.

Content

The dataset contains the latest NPI downloadable file in an easy to query BigQuery table, npi_raw. In addition, there is a second table, npi_optimized which harnesses the power of Big Query’s next-generation columnar storage format to provide an analytical view of the NPI data containing description fields for the codes based on the mappings in Data Dissemination Public File - Code Values documentation as well as external lookups to the healthcare provider taxonomy codes . While this generates hundreds of columns, BigQuery makes it possible to process all this data effectively and have a convenient single lookup table for all provider information.

Fork this kernel to get started.

Acknowledgements

https://bigquery.cloud.google.com/dataset/bigquery-public-data:nppes?_ga=2.117120578.-577194880.1523455401

https://console.cloud.google.com/marketplace/details/hhs/nppes?filter=category:science-research

Dataset Source: Center for Medicare and Medicaid Services. This dataset is publicly available for anyone to use under the following terms provided by the Dataset Source - http://www.data.gov/privacy-policy#data_policy — and is provided "AS IS" without any warranty, express or implied, from Google. Google disclaims all liability for any damages, direct or indirect, resulting from the use of the dataset.

Banner Photo by @rawpixel from Unplash.

Inspiration

What are the top ten most common types of physicians in Mountain View?

What are the names and phone numbers of dentists in California who studied public health?

The CMS Program Statistics - Medicare Providers summary tables provide data on institutional (i.e., hospitals, skilled nursing facilities, home health agencies, hospices, etc.) and non-institutional (i.e., physicians, nonphysicians, specialists, and suppliers) providers. For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. Below is the list of tables: MDCR PROVIDERS 1. Medicare Providers: Number of Medicare Certified Institutional Providers, Yearly Trend MDCR PROVIDERS 2. Medicare Providers: Number of Medicare Certified Inpatient Hospital and Skilled Nursing Facility Beds and Beds Per 1,000 Enrollees, Yearly Trend MDCR PROVIDERS 3. Medicare Providers: Number of Medicare Certified Facilities, by Type of Control, Yearly Trend MDCR PROVIDERS 4. Medicare Providers: Number of Skilled Nursing Facilities and Medicare Certified Hospitals, and Number of Beds, by State, Territories, Possessions and Other Areas MDCR PROVIDERS 5. Medicare Providers: Number of Medicare Certified Providers, by Type of Provider, by State, Territories, Possessions, and Other Areas MDCR PROVIDERS 6. Medicare Providers: Number of Medicare Non-Institutional Providers by Specialty, Yearly Trend MDCR PROVIDERS 7. Medicare Providers: Number of Medicare Non-Institutional Providers, by State, Territories, Possessions, and Other Areas, Yearly Trend

This is a random sampling of the 2022 public data set hosted by the Center for Medicare & Medicaid Services at:

https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service

The complete data set for 2022 can be found there. This random sampling has 292,663 rows and 29 columns. The full set hosted at the link above is about 3GB in size with 9,755,427 rows and 29 columns. The 29 columns are:

1. National Provider Identifier (Rndrng_NPI)
2. Last Name/Organization Name of the Provider (Rndrng_Prvdr_Last_Org_Name)
3. First Name of the Provider (Rndrng_Prvdr_First_Name)
4. Middle Initial of the Provider (Rndrng_Prvdr_MI)
5. Credentials of the Provider (Rndrng_Prvdr_Crdntls)
6. Gender of the Provider (Rndrng_Prvdr_Gndr)
7. Entity Type of the Provider (Rndrng_Prvdr_Ent_Cd)
8. Street Address 1 of the Provider (Rndrng_Prvdr_St1)
9. Street Address 2 of the Provider (Rndrng_Prvdr_St2)
10. City of the Provider (Rndrng_Prvdr_City)
11. State Abbreviation of the Provider (Rndrng_Prvdr_State_Abrvtn)
12. State FIPS Code of the Provider (Rndrng_Prvdr_State_FIPS)
13. Zip Code of the Provide (Rndrng_Prvdr_Zip5)
14. RUCA Code of the Provider (Rndrng_Prvdr_RUCA)
15. RUCA Description (Rndrng_Prvdr_RUCA_Desc)
16. Country Code of the Provider (Rndrng_Prvdr_Cntry)
17. Provider Type of the Provider (Rndrng_Prvdr_Type)
18. Medicare Participation Indicator (Rndrng_Prvdr_Mdcr_Prtcptg_Ind)
19. HCPCS Code (HCPCS_Cd)
20. HCPCS Description (HCPCS_Desc)
21. HCPCS Drug Indicator (HCPCS_Drug_Ind)
22. Place of Service (Place_Of_Srvc)
23. Number of Medicare Beneficiaries (Tot_Benes)
24. Number of Services (Tot_Srvcs)
25. Number of Distinct Medicare Beneficiary/Per Day Services (Tot_Bene_Day_Srvcs)
26. Average Submitted Charge Amount (Avg_Sbmtd_Chrg)
27. Average Medicare Allowed Amount (Avg_Mdcr_Alowd_Amt)
28. Average Medicare Payment Amount (Avg_Mdcr_Pymt_Amt)
29. Average Medicare Standardized Payment Amount (Avg_Mdcr_Stdzd_Amt)

A brief description of each these columns can be found here:

https://data.cms.gov/resources/medicare-physician-other-practitioners-by-provider-and-service-data-dictionary

A full description of the data is in the 27-page document, "Medicare Fee-For-Service Provider Utilization & Payment Data Physician and Other Supplier Public Use File: A Methodological Overview" which can be found here:

www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/medicare-provider-charge-data/downloads/medicare-physician-and-other-supplier-puf-methodology.pdf

This data set is similar to the one posted by Tamil Selvan here https://www.kaggle.com/datasets/tamilsel/healthcare-providers-data. That data's origin is unclear, however it is very likely from same source. It has different header text and may be from one of the earlier years.

Content

More details about each file are in the individual file descriptions.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

This dataset is distributed under the following licenses: Public Domain, NA

The Medicare Physician & Other Practitioners by Provider dataset provides information on use, payments, submitted charges and beneficiary demographic and health characteristics organized by National Provider Identifier (NPI).

The Medicare Fee-For-Service Public Provider Enrollment dataset includes information on providers who are actively approved to bill Medicare or have completed the 855O at the time the data was pulled from the Provider Enrollment, Chain, and Ownership System (PECOS). The release of this provider enrollment data is not related to other provider information releases such as Physician Compare or Data Transparency. Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.Resources for Using and Understanding the DataThese files are populated from PECOS and contain basic enrollment and provider information, reassignment of benefits information and practice location city, state and zip. These files are not intended to be used as real time reporting as the data changes from day to day and the files are updated only on a quarterly basis. If any information on these files needs to be updated, the provider needs to contact their respective Medicare Administrative Contractor (MAC) to have that information updated. This data does not include information on opt-out providers. Information is redacted where necessary to protect Medicare provider privacy.

The CMS Program Statistics - Medicare Physician, Non-Physician Practitioner and Supplier tables provide use and payment data for physicians, other practitioners, limited-licensed practitioners, and durable medical equipment, prosthetic, and orthotic (DMEPOS) suppliers.

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

Below is the list of tables:

MDCR PHYSSUPP 1. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, Cost Sharing, and Balance Billing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend
MDCR PHYSSUPP 2. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, Cost Sharing, and Balance Billing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status
MDCR PHYSSUPP 3. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, Cost Sharing, and Balance Billing for Original Medicare Beneficiaries, by Area of Residence
MDCR PHYSSUPP 4. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, and Balance Billing for Original Medicare Beneficiaries, by Type of Service
MDCR PHYSSUPP 5. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, and Balance Billing for Original Medicare Beneficiaries, by Place of Service
MDCR PHYSSUPP 6. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, and Balance Billing for Original Medicare Beneficiaries, by Physician Specialty
MDCR PHYSSUPP 7. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization and Program Payments for Original Medicare Beneficiaries, by Berenson-Eggers Type of Service (BETOS) Classification

Please be advised that as of Q4 2023 there is a new Provider of Service file (POS) that contains the provider and certification details for Home Health Agencies (HHAs), Hospices, and Ambulatory Surgical Centers (ASCs). Data contained in this file are extracted from the Internet Quality Improvement and Evaluation System (iQIES) environment and will be updated quarterly along with the other two POS files. The Provider of Services File - Hospital & Non-Hospital Facilities data provide critical resources for other federal regulator requirements as well as supports the ongoing quality & research efforts sponsored by CMS. In this file you will find provider certification, termination, accreditation, ownership, name, location and other characteristics organized by CMS Certification Number.

This dataset identifies providers in Utah by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.

The Medicare Physician & Other Practitioners by Provider and Service dataset provides information on use, payments, and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service.

Content

************************PLEASE NOTE**************************

This dataset will no longer be updated effective 2/25/2019

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

Cover photo by rawpixel on Unsplash
Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA

Information on Open Payments managed by the Centers for Medicare & Medicaid Services (CMS), which is a national disclosure program created by the Affordable Care Act (ACA) that promotes transparency and accountability by helping consumers understand the financial relationships between pharmaceutical and medical device industries and physicians and teaching hospitals.

Maps secondary/duplicate provider profile IDs to the primary ID in the Open Payments system. For multiple reasons, a small number of providers have more than one ID in the payments records.

Content

This crosswalk links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the appropriate Healthcare Provider Taxonomy Codes. This crosswalk includes the Medicare Specialty Codes for those provider/supplier types who have Medicare Specialty Codes. The Healthcare Provider Taxonomy Code Set is available from the Washington Publishing Company (www.wpc-edi.com) and is maintained by the National Uniform Claim Committee (www.nucc.org). The code set is updated twice a year, with the updates being effective April 1 and October 1 of each year. This document reflects Healthcare Provider Taxonomy Codes effective for use on April 2, 2018.

When changes are made to Medicare provider enrollment requirements, the Medicare Specialty Codes, or the Healthcare Provider Taxonomy Code Set, this document may need to be revised.

NOTE: This document does not alter existing Medicare claims preparation, processing, or payment instructions, nor does it alter existing Medicare provider enrollment requirements or policies.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

Cover photo by Markus Spiske on Unsplash
Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA

The Centers for Medicare & Medicaid Services (CMS) Provider of Services (POS) file contains data on characteristics of hospitals and other types of healthcare facilities, including the name and address of the facility and the type of Medicare services the facility provides, among other information.

The Other file contains information on non-CLIA facilities, such as hospitals, nursing facilities, home health agencies, and more (18 categories)

Information on utilization and payment data for Home health agency, Hospice, skilled nursing facitlity. Information on Inpatient Prospective Payment System (IPPS) payments, Inpatient Rehabilitation Facilities (IRFs)

The CMS Program Statistics – Medicare Advantage, Physician, Non-Physician Practitioner and Supplier tables provide utilization data for physician, non-physician practitioners, and suppliers, by Medicare Advantage beneficiaries.

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

Below is the list of tables:

MDCR PHYSSUPP MA 1. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization for Medicare Advantage Beneficiaries, by Type of Entitlement, Yearly Trend
MDCR PHYSSUPP MA 2. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization for Medicare Advantage Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status
MDCR PHYSSUPP MA 3. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization for Medicare Advantage Beneficiaries, by Area of Residence
MDCR PHYSSUPP MA 4. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization for Medicare Advantage Beneficiaries, by Place of Service
MDCR PHYSSUPP MA 5. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization for Medicare Advantage Beneficiaries, by Restructured BETOS Classification System

The Revalidation Due Date List dataset contains revalidation due dates for Medicare providers who are due to revalidate in the following six months. If a provider's due date does not fall within the ensuing six months, the due date is marked 'TBD'. In addition the dataset also includes subfiles with reassignment information for a given provider as well as due date listings for clinics and group practices and their providers. Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

Content

This file is a point in time snapshot of enrollment level data for providers actively enrolled in Medicare.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

Cover photo by Annie Spratt on Unsplash
Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA