Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2014

data.cms.gov | Last Updated 31 Oct 2017

The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. 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.

Tags: medicare, physician, supplier, 2014, utilization, payment, cpt, hcpcs, npi, mpup

This dataset has the following 70 columns:

Column NameAPI Column NameData TypeDescriptionSample Values
National Provider Identifiernational_provider_identifiertextNational Provider Identifier (NPI) for the performing provider on the claim.
Last Name/Organization Name of the Providerlast_name_organization_name_of_the_providertextWhen 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.
First Name of the Providerfirst_name_of_the_providertextWhen 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.
Middle Initial of the Providermiddle_initial_of_the_providertextWhen 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.
Credentials of the Providercredentials_of_the_providertextWhen 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.
Gender of the Providergender_of_the_providertextWhen 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.
Entity Type of the Providerentity_type_of_the_providertextType 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.
Street Address 1 of the Providerstreet_address_1_of_the_providertextThe first line of the provider’s street address, as reported in NPPES.
Street Address 2 of the Providerstreet_address_2_of_the_providertextThe second line of the provider’s street address, as reported in NPPES.
City of the Providercity_of_the_providertextThe city where the provider is located, as reported in NPPES.
Zip Code of the Providerzip_code_of_the_providertextThe provider’s zip code, as reported in NPPES.
State Code of the Providerstate_code_of_the_providertextThe 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. The following values are used for other areas: 'XX' = 'Unknown' 'AA' = 'Armed Forces Central/South America' 'AE' = 'Armed Forces Europe' 'AP' = 'Armed Forces Pacific' 'AS' = 'American Samoa' 'GU' = 'Guam' 'MP' = 'North Mariana Islands' 'PR' = 'Puerto Rico' 'VI' = 'Virgin Islands' 'ZZ' = 'Foreign Country'
Country Code of the Providercountry_code_of_the_providertextThe country where the provider is located, as reported in NPPES. The country code will be ‘US’ for any state or U.S. possession. For foreign countries (i.e., state values of ‘ZZ’), the provider country values include the following: ‘AE’ = ‘United Arab Emirates’; 'AG'='Antigua'; ‘AR’= ‘Argentina’; ‘AU’= ‘Australia’; 'BO'='Bolivia'; ‘BR’= ‘Brazil’; ‘CA’= ‘Canada’; ‘CH’= Switzerland’; ‘CN’= China’; ‘CO’= Colombia’; ‘DE’= ‘Germany’; ‘ES’= ‘Spain’; ‘FR’= France’; ‘GB’= Great Britain’; ‘HU’= Hungary’; ‘IL’= Israel’; ‘IN’= India’; ‘IS’= Iceland; ‘IT’= Italy’; ‘JP’= Japan’; ‘KR’= ‘Korea’; 'KW'='Kuwait'; 'KY'='Cayman Islands'; 'LB'='Lebanon'; 'MX'='Mexico'; ‘NL’= ‘Netherlands’; 'NO'='Norway'; 'NZ'='New Zealand'; 'PA'='Panama'; ‘PK’= ‘Pakistan’; 'RW'='Rwanda'; ‘SA’= ‘Saudi Arabia’; ‘SY’= ‘Syria’; ‘TR’= ‘Turkey’; ' TH'='Thailand'; ‘VE’= ‘Venezuela’ .
Provider Type of the Providerprovider_type_of_the_providertextDerived 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.
Medicare Participation Indicatormedicare_participation_indicatortextIdentifies whether the provider participates in Medicare and/or accepts assignment of Medicare allowed amounts. The value will be ‘Y’ for any provider that had at least one claim identifying the provider as participating in Medicare or accepting assignment of Medicare allowed amounts.
Number of HCPCSnumber_of_hcpcsnumberTotal number of unique HCPCS codes.
Number of Servicesnumber_of_servicesnumberTotal provider services.
Number of Medicare Beneficiariesnumber_of_medicare_beneficiariesnumberTotal 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.
Total Submitted Charge Amounttotal_submitted_charge_amountnumberThe total charges that the provider submitted for all services.
Total Medicare Allowed Amounttotal_medicare_allowed_amountnumberThe 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.
Total Medicare Payment Amounttotal_medicare_payment_amountnumberTotal amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.
Total Medicare Standardized Payment Amounttotal_medicare_standardized_payment_amountnumberTotal 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.
Drug Suppress Indicatordrug_suppress_indicatortextIdentifies 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. An '*' identifies that the suppressed information is based on fewer than 11 beneficiaries and a '#' identifies that the information has been counter suppressed to prevent the re-calculation of information suppressed due to fewer than 11 beneficiaries. For example, if the information associated with Drug services has been suppressed because fewer than 11 beneficiaries received these services from a provider, then the information associated with Medical services must also be suppressed so that the information associated with Drug services can not be recalculated by subtracting the Medical values from the provider's overall values.
Number of HCPCS Associated With Drug Servicesnumber_of_hcpcs_associated_with_drug_servicesnumberTotal number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File.
Number of Drug Servicesnumber_of_drug_servicesnumberTotal drug services, as defined from the Medicare Part B Drug ASP File.
Number of Medicare Beneficiaries With Drug Servicesnumber_of_medicare_beneficiaries_with_drug_servicesnumberTotal Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.
Total Drug Submitted Charge Amounttotal_drug_submitted_charge_amountnumberThe total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.
Total Drug Medicare Allowed Amounttotal_drug_medicare_allowed_amountnumberThe 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.
Total Drug Medicare Payment Amounttotal_drug_medicare_payment_amountnumberTotal amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item drug services, as defined from the Medicare Part B Drug ASP File.
Total Drug Medicare Standardized Payment Amounttotal_drug_medicare_standardized_payment_amountnumberTotal 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. 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.
Medical Suppress Indicatormedical_suppress_indicatortextIdentifies whether the utilization, cost and payment information associated with HCPCS codes for Medical (non-ASP) services have been suppressed. An '*' identifies that the suppressed information is based on fewer than 11 beneficiaries and a '#' identifies that the information has been counter suppressed to prevent the re-calculation of information suppressed due to fewer than 11 beneficiaries. For example, if the information associated with Medical (non-ASP) services has been suppressed because fewer than 11 beneficiaries received these services from a provider, then the information associated with Drug services must also be suppressed so that the information associated with Medical services can not be recalculated by subtracting the Drug values from the provider's overall values.
Number of HCPCS Associated With Medical Servicesnumber_of_hcpcs_associated_with_medical_servicesnumberTotal number of HCPCS codes associated with medical (non-ASP) services.
Number of Medical Servicesnumber_of_medical_servicesnumberTotal medical (non-ASP) services.
Number of Medicare Beneficiaries With Medical Servicesnumber_of_medicare_beneficiaries_with_medical_servicesnumberTotal Medicare beneficiaries receiving medical (non-ASP) services.
Total Medical Submitted Charge Amounttotal_medical_submitted_charge_amountnumberThe total charges that the provider submitted for medical services (non-ASP).
Total Medical Medicare Allowed Amounttotal_medical_medicare_allowed_amountnumberThe 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.
Total Medical Medicare Payment Amounttotal_medical_medicare_payment_amountnumberTotal amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services.
Total Medical Medicare Standardized Payment Amounttotal_medical_medicare_standardized_payment_amountnumberTotal 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.
Average Age of Beneficiariesaverage_age_of_beneficiariesnumberAverage age of beneficiaries. Beneficiary age is calculated at the end of the calendar year or at the time of death.
Number of Beneficiaries Age Less 65number_of_beneficiaries_age_less_65numberNumber of beneficiaries under the age of 65. Beneficiary age is calculated at the end of the calendar year or at the time of death.
Number of Beneficiaries Age 65 to 74number_of_beneficiaries_age_65_to_74numberNumber 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.
Number of Beneficiaries Age 75 to 84number_of_beneficiaries_age_75_to_84numberNumber 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.
Number of Beneficiaries Age Greater 84number_of_beneficiaries_age_greater_84numberNumber of beneficiaries over the age of 84. Beneficiary age is calculated at the end of the calendar year or at the time of death.
Number of Female Beneficiariesnumber_of_female_beneficiariesnumberNumber of female beneficiaries.
Number of Male Beneficiariesnumber_of_male_beneficiariesnumberNumber of male beneficiaries.
Number of Non-Hispanic White Beneficiariesnumber_of_non_hispanic_white_beneficiariesnumberNumber of non-Hispanic white beneficiaries.
Number of Black or African American Beneficiariesnumber_of_black_or_african_american_beneficiariesnumberNumber of non-Hispanic black or African American beneficiaries.
Number of Asian Pacific Islander Beneficiariesnumber_of_asian_pacific_islander_beneficiariesnumberNumber of Asian Pacific Islander beneficiaries.
Number of Hispanic Beneficiariesnumber_of_hispanic_beneficiariesnumberNumber of Hispanic beneficiaries.
Number of American Indian/Alaska Native Beneficiariesnumber_of_american_indian_alaska_native_beneficiariesnumberNumber of American Indian or Alaska Native beneficiaries.
Number of Beneficiaries With Race Not Elsewhere Classifiednumber_of_beneficiaries_with_race_not_elsewhere_classifiednumberNumber of beneficiaries with race not elsewhere classified.
Number of Beneficiaries With Medicare Only Entitlementnumber_of_beneficiaries_with_medicare_only_entitlementnumberNumber 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.
Number of Beneficiaries With Medicare & Medicaid Entitlementnumber_of_beneficiaries_with_medicare_medicaid_entitlementnumberNumber 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.
Percent (%) of Beneficiaries Identified With Atrial Fibrillationpercent_of_beneficiaries_identified_with_atrial_fibrillationnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation.
Percent (%) of Beneficiaries Identified With Alzheimer’s Disease or Dementiapercent_of_beneficiaries_identified_with_alzheimer_s_disease_or_dementianumberPercent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia.
Percent (%) of Beneficiaries Identified With Asthmapercent_of_beneficiaries_identified_with_asthmanumberPercent of beneficiaries meeting the CCW chronic condition algorithm for Asthma.
Percent (%) of Beneficiaries Identified With Cancerpercent_of_beneficiaries_identified_with_cancernumberPercent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer.
Percent (%) of Beneficiaries Identified With Heart Failurepercent_of_beneficiaries_identified_with_heart_failurenumberPercent of beneficiaries meeting the CCW chronic condition algorithm for heart failure.
Percent (%) of Beneficiaries Identified With Chronic Kidney Diseasepercent_of_beneficiaries_identified_with_chronic_kidney_diseasenumberPercent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease.
Percent (%) of Beneficiaries Identified With Chronic Obstructive Pulmonary Diseasepercent_of_beneficiaries_identified_with_chronic_obstructive_pulmonary_diseasenumberPercent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease.
Percent (%) of Beneficiaries Identified With Depressionpercent_of_beneficiaries_identified_with_depressionnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for depression.
Percent (%) of Beneficiaries Identified With Diabetespercent_of_beneficiaries_identified_with_diabetesnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for diabetes.
Percent (%) of Beneficiaries Identified With Hyperlipidemiapercent_of_beneficiaries_identified_with_hyperlipidemianumberPercent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia.
Percent (%) of Beneficiaries Identified With Hypertensionpercent_of_beneficiaries_identified_with_hypertensionnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for hypertension.
Percent (%) of Beneficiaries Identified With Ischemic Heart Diseasepercent_of_beneficiaries_identified_with_ischemic_heart_diseasenumberPercent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease.
Percent (%) of Beneficiaries Identified With Osteoporosispercent_of_beneficiaries_identified_with_osteoporosisnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis.
Percent (%) of Beneficiaries Identified With Rheumatoid Arthritis / Osteoarthritispercent_of_beneficiaries_identified_with_rheumatoid_arthritis_osteoarthritisnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis.
Percent (%) of Beneficiaries Identified With Schizophrenia / Other Psychotic Disorderspercent_of_beneficiaries_identified_with_schizophrenia_other_psychotic_disordersnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders.
Percent (%) of Beneficiaries Identified With Strokepercent_of_beneficiaries_identified_with_strokenumberPercent of beneficiaries meeting the CCW chronic condition algorithm for stroke.
Average HCC Risk Score of Beneficiariesaverage_hcc_risk_score_of_beneficiariesnumberAverage Hierarchical Condition Category (HCC) risk score of beneficiaries.