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.

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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.

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Inspiration

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

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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 Medicare Durable Medical Equipment, Devices & Supplies by Referring Provider dataset contains information on usage, payments, submitted charges and beneficiary demographic and health characteristics organized by National Provider Identifier (NPI).

Nursing Home Compare has detailed information about every Medicare and Medicaid nursing home in the country. A nursing home is a place for people who can’t be cared for at home and need 24-hour nursing care. These are the official datasets used on the Medicare.gov Nursing Home Compare Website provided by the Centers for Medicare & Medicaid Services. These data allow you to compare the quality of care at every Medicare and Medicaid-certified nursing home in the country, including over 15,000 nationwide.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans. This dataset reflects individual provider data. Provider Network Data System information is self-reported. For more information, check out http://www.health.ny.gov/health_care/managed_care/.

We are releasing data that compares the HHS Provider Relief Fund and the CMS Accelerated and Advance Payments by State and provider as of May 15, 2020. This data is already available on other websites, but this chart brings the information together into one view for comparison. You can find additional information on the Accelerated and Advance Payments at the following links:

Fact Sheet: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf;

Zip file on providers in each state: https://www.cms.gov/files/zip/accelerated-payment-provider-details-state.zip

Medicare Accelerated and Advance Payments State-by-State information and by Provider Type: https://www.cms.gov/files/document/covid-accelerated-and-advance-payments-state.pdf.

This file was assembled by HHS via CMS, HRSA and reviewed by leadership and compares the HHS Provider Relief Fund and the CMS Accelerated and Advance Payments by State and provider as of December 4, 2020.

HHS Provider Relief Fund President Trump is providing support to healthcare providers fighting the coronavirus disease 2019 (COVID-19) pandemic through the bipartisan Coronavirus Aid, Relief, & Economic Security Act and the Paycheck Protection Program and Health Care Enhancement Act, which provide a total of $175 billion for relief funds to hospitals and other healthcare providers on the front lines of the COVID-19 response. This funding supports healthcare-related expenses or lost revenue attributable to COVID-19 and ensures uninsured Americans can get treatment for COVID-19. HHS is distributing this Provider Relief Fund money and these payments do not need to be repaid. The Department allocated $50 billion of the Provider Relief Fund for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers' net reimbursement. It allocated another $22 billion to providers in areas particularly impacted by the COVID-19 outbreak, rural providers, and providers who serve low-income populations and uninsured Americans. HHS will be allocating the remaining funds in the near future.

As part of the Provider Relief Fund distribution, all providers have 45 days to attest that they meet certain criteria to keep the funding they received, including public disclosure. As of May 15, 2020, there has been a total of $34 billion in attested payments. The chart only includes those providers that have attested to the payments by that date. We will continue to update this information and add the additional providers and payments once their attestation is complete.

CMS Accelerated and Advance Payments Program On March 28, 2020, to increase cash flow to providers of services and suppliers impacted by the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers. Beginning on April 26, 2020, CMS stopped accepting new applications for the Advance Payment Program, and CMS began reevaluating all pending and new applications for Accelerated Payments in light of the availability of direct payments made through HHS’s Provider Relief Fund.

Since expanding the AAP program on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals, through May 18, 2020. For Part B suppliers—including doctors, non-physician practitioners and durable medical equipment suppliers— during the same time period, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP program is not a grant, and providers and suppliers are required to repay the loan.

CMS has published AAP data, as required by the Continuing Appropriations and Other Extensions Act of 2021, on this website: https://www.cms.gov/files/document/covid-medicare-accelerated-and-advance-payments-program-covid-19-public-health-emergency-payment.pdf

The Skilled Nursing Facility (SNF) Cost Report dataset is a public use file that provides select measures from the skilled nursing facility annual cost report. This data includes provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data organized by CMS Certification Number.

The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number 6-digit provider identification number, and state. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2014 and contains 100 percent final-action i.e., all claim adjustments have been resolved, hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Although the Hospice PUF has a wealth of payment and utilization information about hospice services, the data set also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual hospice providers. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in patient populations. For additional limitations, please review the methodology document available below.

The Hospital Provider Cost Report dataset provides select measures from the hospital annual cost report. This data includes provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data organized by CMS Certification Number.

The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100 percent final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

The CMS IPBS PUFs are aggregated files in which each record summarizes information for a particular institutional provider. An institutional provider refers to a hospital, a critical care facility, a skilled nursing facility, a home health agency or hospice or another similar institution providing services to Medicare beneficiaries. Information about individual beneficiaries is not reported.

The Shared Savings Program Performance Year Financial and Quality Results data provides Medicare Shared Savings Program (Shared Savings Program) ACO-specific quality, expenditure, benchmark, and shared savings/loss metrics, as well as summarized beneficiary and provider information for each performance year of the Shared Savings Program.

DISCLAIMER: This information is current as of the last update. Changes to Shared Savings Program ACO information occur periodically. Each Shared Savings Program ACO has the most up-to-date information about their organization. Consider contacting the Shared Savings Program ACO for the latest information. Contact information is available in the ACO Public Use File (PUF) and the ACO Participants PUF.

The Individual Provider Network Data displays information on individuals participating in health plan networks from January through March 2020. Plan network data is collected from Medicaid, Commercial, and Exchange plans on a quarterly basis by the Department of Health, including managed care plans, as well as PPO/EPO plans. For more information, please visit https://pndslookup.health.ny.gov.

The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers 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. Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.

A list of all health deficiencies currently listed on Nursing Home Compare including the second most recent comprehensive inspection and complaint inspections that occurred 13-24 months from the date the data were uploaded. Because of the new health inspection process, these deficiencies aren’t necessarily used to calculate the 5-star health inspection rating. For the specific data used to calculate that rating, see the Provider Info table.

The Medicare Outpatient Hospitals by Provider and Service dataset provides information on services for Original Medicare Part B beneficiaries by OPPS hospitals. These datasets contain information on the number of services, payments, and submitted charges organized by provider CMS Certified Number (CCN) and comprehensive Ambulatory Payment Classification (APC).

The Hospital All Owners Information dataset provides information on all owners of the hospitals. This data includes ownership information such as ownership name, ownership type, ownership address and ownership effective date.

Provider Directory Software Market Outlook

According to our latest research, the global Provider Directory Software market size reached USD 1.74 billion in 2024, reflecting robust adoption across healthcare and insurance sectors. The market is experiencing strong momentum with a recorded CAGR of 10.2% from 2025 to 2033. By 2033, the market is forecasted to reach USD 4.18 billion, driven by regulatory mandates, increasing digitization in healthcare, and the need for accurate, real-time provider information. The growth is further fueled by the growing emphasis on interoperability, patient engagement, and the demand for cost-effective healthcare administration solutions.

The surge in the Provider Directory Software market can be primarily attributed to the escalating need for accurate, up-to-date, and easily accessible provider information. Healthcare organizations, insurance companies, and regulatory bodies worldwide are increasingly mandating the use of digital provider directories to reduce administrative errors, streamline provider-patient matching, and enhance member satisfaction. Inaccurate provider data has historically resulted in claim denials, compliance violations, and poor patient experiences. As a result, the adoption of comprehensive provider directory software is becoming a strategic imperative for organizations aiming to mitigate risk and improve operational efficiency. The integration of advanced technologies such as artificial intelligence, machine learning, and blockchain is further elevating the capabilities of these solutions, enabling real-time data synchronization, automated data validation, and enhanced security.

Another significant growth factor is the evolving regulatory landscape, particularly in regions like North America and Europe. Governments and healthcare authorities are implementing stringent regulations that require payers and providers to maintain accurate, accessible, and regularly updated provider directories. For instance, the Centers for Medicare & Medicaid Services (CMS) in the United States has established rigorous standards for provider data accuracy, with non-compliance resulting in substantial financial penalties. This regulatory pressure is compelling healthcare organizations to invest in robust provider directory software that ensures compliance, reduces administrative burdens, and improves transparency. Furthermore, the ongoing shift towards value-based care and patient-centric healthcare delivery models is amplifying the demand for efficient provider data management systems.

The rapid digital transformation within the healthcare ecosystem is also playing a pivotal role in market expansion. The proliferation of electronic health records (EHRs), telemedicine, and integrated care delivery models necessitates seamless interoperability between disparate systems and stakeholders. Provider directory software acts as a critical enabler by consolidating provider information from multiple sources, ensuring data consistency, and facilitating secure data exchange across networks. The increased focus on patient engagement and experience is driving healthcare organizations to leverage provider directory solutions that offer intuitive search functionalities, real-time availability, and personalized provider recommendations. As digital health initiatives continue to gain traction, the provider directory software market is poised for sustained growth over the forecast period.

From a regional perspective, North America currently holds the largest market share, underpinned by advanced healthcare IT infrastructure, high adoption rates of digital health solutions, and a favorable regulatory environment. Europe follows closely, with growing investments in healthcare digitization and interoperability initiatives. The Asia Pacific region is emerging as a lucrative market, driven by expanding healthcare access, rising investments in health IT, and increasing awareness of the importance of accurate provider data. Latin America and the Middle East & Africa are also witnessing gradual adoption, supported by government-led digital health programs and the modernization of healthcare systems. Overall, the global provider directory software market is characterized by dynamic growth, evolving regulatory requirements, and increasing technological innovation.

Archived as of 6/26/2025: The datasets will no longer receive updates but the historical data will continue to be available for download. This dataset provides information related to the claims that serviced mental health patients. It contains information about the total number of patients, total number of claims, and total dollar amount, grouped by provider. Restricted to claims with service date between 01/2016 to 12/2016. Patients with mental health problems is identified by a list of mental health patients matched to their Medicaid recipient id from DMHA. ER claims are defined as claims with CPT codes: 99281, 99282, 99283, 99284, and 99285. Providers are billing providers. This data is for research purposes and is not intended to be used for reporting. Due to differences in geographic aggregation, time period considerations, and units of analysis, these numbers may differ from those reported by FSSA.

This Provider Network Data file contains information on individual providers and institutional providers (i.e., hospitals, labs, home care agencies) participating in health plan networks from April through June 2022. Plan network data is collected from Medicaid, Commercial, and Exchange plans on a quarterly basis by the Department of Health, including Managed Care Organizations (MCOs), Preferred Provider Organizations (PPOs) and Exclusive Provider Organizations (EPOs) plans.

For more information, please visit: https://pndslookup.health.ny.gov