Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2016

data.cms.gov | Last Updated 14 Jun 2018

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: npi, aggregate, physician, 2016, mpup

This dataset has the following 70 columns:

Column NameAPI Column NameData TypeDescriptionSample Values
National Provider IdentifiernpitextNational Provider Identifier (NPI) for the performing provider on the claim. The provider NPI is the numeric identifier registered in NPPES.
Last Name/Organization Name of the Providernppes_provider_last_org_nametextWhen 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 Providernppes_provider_first_nametextWhen 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 Providernppes_provider_mitextWhen 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 Providernppes_credentialstextWhen 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 Providernppes_provider_gendertextWhen 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 Providernppes_entity_codetextType 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 Providernppes_provider_street1textThe first line of the provider’s street address, as reported in NPPES.
Street Address 2 of the Providernppes_provider_street2textThe second line of the provider’s street address, as reported in NPPES.
City of the Providernppes_provider_citytextThe city where the provider is located, as reported in NPPES.
Zip Code of the Providernppes_provider_ziptextThe provider’s zip code, as reported in NPPES.
State Code of the Providernppes_provider_statetextThe 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 Providernppes_provider_countrytextThe 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_typetextDerived 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 Servicestotal_servicesnumberTotal provider services.
Number of Medicare Beneficiariestotal_unique_benesnumberTotal 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_chrg_amtnumberThe total charges that the provider submitted for all services.
Total Medicare Allowed Amounttotal_medicare_allowed_amtnumberThe 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_amtnumberTotal 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_stnd_amtnumberTotal 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_drug_hcpcsnumberTotal number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File.
Number of Drug Servicestotal_drug_servicesnumberTotal drug services, as defined from the Medicare Part B Drug ASP File.
Number of Medicare Beneficiaries With Drug Servicestotal_drug_unique_benesnumberTotal Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.
Total Drug Submitted Charge Amounttotal_drug_submitted_chrg_amtnumberThe 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_amtnumberThe 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_amtnumberTotal 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_stnd_amtnumberTotal 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 Indicatormed_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_med_hcpcsnumberTotal number of HCPCS codes associated with medical (non-ASP) services.
Number of Medical Servicestotal_med_servicesnumberTotal medical (non-ASP) services.
Number of Medicare Beneficiaries With Medical Servicestotal_med_unique_benesnumberTotal Medicare beneficiaries receiving medical (non-ASP) services.
Total Medical Submitted Charge Amounttotal_med_submitted_chrg_amtnumberThe total charges that the provider submitted for medical services (non-ASP).
Total Medical Medicare Allowed Amounttotal_med_medicare_allowed_amtnumberThe 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_med_medicare_payment_amtnumberTotal 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_med_medicare_stnd_amtnumberTotal 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 Beneficiariesbeneficiary_average_agenumberAverage 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 65beneficiary_age_less_65_countnumberNumber 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 74beneficiary_age_65_74_countnumberNumber 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 84beneficiary_age_75_84_countnumberNumber 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 84beneficiary_age_greater_84_countnumberNumber 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 Beneficiariesbeneficiary_female_countnumberNumber of female beneficiaries.
Number of Male Beneficiariesbeneficiary_male_countnumberNumber of Male Beneficiaries
Number of Non-Hispanic White Beneficiariesbeneficiary_race_white_countnumberNumber of Non-Hispanic White Beneficiaries
Number of Black or African American Beneficiariesbeneficiary_race_black_countnumberNumber of Black or African American Beneficiaries
Number of Asian Pacific Islander Beneficiariesbeneficiary_race_api_countnumberNumber of Asian Pacific Islander Beneficiaries
Number of Hispanic Beneficiariesbeneficiary_race_hispanic_countnumberNumber of Hispanic Beneficiaries
Number of American Indian/Alaska Native Beneficiariesbeneficiary_race_natind_countnumberNumber of American Indian/Alaska Native Beneficiaries
Number of Beneficiaries With Race Not Elsewhere Classifiedbeneficiary_race_other_countnumberNumber of Beneficiaries With Race Not Elsewhere Classified
Number of Beneficiaries With Medicare Only Entitlementbeneficiary_nondual_countnumberNumber 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 Entitlementbeneficiary_dual_countnumberNumber 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 Fibrillationbeneficiary_cc_afib_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation.
Percent (%) of Beneficiaries Identified With Alzheimer’s Disease or Dementiabeneficiary_cc_alzrdsd_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia.
Percent (%) of Beneficiaries Identified With Asthmabeneficiary_cc_asthma_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for Asthma.
Percent (%) of Beneficiaries Identified With Cancerbeneficiary_cc_cancer_percentnumberPercent 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 Failurebeneficiary_cc_chf_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for heart failure.
Percent (%) of Beneficiaries Identified With Chronic Kidney Diseasebeneficiary_cc_ckd_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease.
Percent (%) of Beneficiaries Identified With Chronic Obstructive Pulmonary Diseasebeneficiary_cc_copd_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease.
Percent (%) of Beneficiaries Identified With Depressionbeneficiary_cc_depr_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for depression.
Percent (%) of Beneficiaries Identified With Diabetesbeneficiary_cc_diab_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for diabetes.
Percent (%) of Beneficiaries Identified With Hyperlipidemiabeneficiary_cc_hyperl_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia.
Percent (%) of Beneficiaries Identified With Hypertensionbeneficiary_cc_hypert_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for hypertension.
Percent (%) of Beneficiaries Identified With Ischemic Heart Diseasebeneficiary_cc_ihd_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease.
Percent (%) of Beneficiaries Identified With Osteoporosisbeneficiary_cc_ost_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis.
Percent (%) of Beneficiaries Identified With Rheumatoid Arthritis / Osteoarthritisbeneficiary_cc_raoa_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis.
Percent (%) of Beneficiaries Identified With Schizophrenia / Other Psychotic Disordersbeneficiary_cc_schiot_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders.
Percent (%) of Beneficiaries Identified With Strokebeneficiary_cc_strk_percentnumberPercent of beneficiaries meeting the CCW chronic condition algorithm for stroke.
Average HCC Risk Score of Beneficiariesbeneficiary_average_risk_scorenumberAverage Hierarchical Condition Category (HCC) risk score of beneficiaries.