Health Providers DB includes the Doctors and Clinicians National Provider Data Catalog from the Centers for Medicare & Medicaid Services (CMS) database in the Healthcare Provider’s profile.
The Provider Data Catalog includes information about doctors, clinicians, and groups participating in the Quality Payment Program.
Health Providers DB updates the Healthcare Provider Profiles with the National Providers Data Catalog database twice monthly.
About the Provider Data Catalog
The Centers for Medicare & Medicaid Services (CMS) provides health coverage through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace.
CMS is the federal agency that publishes and maintains the Provider Data Catalog. The information comes primarily from the Provider, Enrollment, Chain, and Ownership System (PECOS) and is checked against Medicare claims data. The Catalog is updated twice a month.
Provider Data Catalog Data Collected
The Health Providers DB includes the following Provider Data Catalog database details. Links to the Open Payments data are provided for reference and research.
https://data.cms.gov/provider-data/dataset/mj5m-pzi6
| Field Name | Description |
|---|---|
| Professional Identification | |
| NPI | Unique clinician ID assigned by NPPES |
| PAC ID | Unique individual clinician ID assigned by PECOS |
| Clinician Enrollment ID | Unique ID for the clinician enrollment that is the source for the data in the observation |
| Provider Last Name | Individual clinician’s first name |
| Provider First Name | The third secondary medical specialty reported by the individual clinician in the selected enrollment |
| Provider Middle Name | Primary Specialty |
| Suffix | Individual clinician suffix |
| Gender | Individual clinician gender |
| Medical Credentials | |
| Credential | Individual clinician’s middle name |
| Medical school name | Individual clinician’s medical school |
| Graduation year | Individual clinician’s medical school graduation year |
| The first secondary medical specialty reported by the individual clinician in the selected enrollment | Primary medical specialty reported by the individual clinician in the selected enrollment |
| Secondary specialty 1 | The second secondary medical specialty reported by the individual clinician in the selected enrollment |
| Secondary specialty 2 | Individual clinician’s last name |
| Secondary specialty 3 | Indicator for whether the group accepts Medicare-approved amounts as payment in full Y = Group accepts Medicare-approved amount as payment in full M = Group may accept Medicare Assignment |
| Secondary specialty 4 | Fourth secondary medical specialty reported by the individual clinician in the selected enrollment |
| All secondary specialties | Number of groups members |
| Medical Practice | |
| Telehealth | Indicator for whether clinician offers telehealth services over video and/or audio Y = Medicare fee-for-service claims indicate that clinician offers telehealth services |
| Facility Name | Legal organization name of the group practice that the individual clinician works with – will be blank if the address is not linked to a group |
| Group PAC ID | Unique group ID assigned by PECOS to the group that the individual clinician works with – will be blank if the address is not linked to a group |
| The total number of individual clinicians affiliated with the group based on Group Practice PAC ID | The marker that the address as reported may be incomplete |
| Line 1 Street Address | Group or individual’s line 1 address |
| Line 2 Street Address | Group or individual’s line 2 address |
| Marker of address line 2 suppression | All secondary medical specialties reported by the individual clinician in the chosen enrollment |
| City/Town | Group or individual’s city |
| State | Group or individual’s state |
| ZIP Code | Group or individual’s ZIP code (9 digits when available) |
| Telephone Number | Phone number is listed only when there is a single phone number available for the address |
| Medicare Assignment | |
| Clinician accepts Medicare Assignment | Indicator for whether the group accepts Medicare-approved amounts as payment in full Y = Group accepts Medicare approved amount as payment in full M = Group may accept Medicare Assignment |
| Group accepts Medicare Assignment | Indicator for whether clinician accepts Medicare-approved amount as payment in full Y = Clinician accepts Medicare-approved amount as payment in full M = Clinician may accept Medicare Assignment |
| Reference | |
| Address ID | Unique identifier for the practice location; offices within the same building, but varied by suite or floor, will have the same Address ID aside from the final two characters |