Medicare Referring Provider DMEPOS NPI Aggregate table, CY2016

data.cms.gov | Last Updated 23 May 2018

The “Medicare Referring Provider DMEPOS NPI Aggregate table” contains information on utilization, payment, and submitted charges organized by Referring Provider NPI. Separate sub totals for durable medical equipment services, prosthetic and orthotic services and drug and nutritional services are included in addition to 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: mpup, dmepos, provider, npi, appgregate, referring, dme, durable medical equipment, 2016

This dataset has the following 86 columns:

Column NameAPI Column NameData TypeDescriptionSample Values
Referring NPIreferring_npitextNPI for the referring provider on the DMEPOS claim.
Referring Provider Last Name / Organization Namereferring_provider_last_name_organization_nametextWhen the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s last name. When the referring provider is registered as an organization (entity type code = ‘O’), this is the organization name.
Referring Provider First Namereferring_provider_first_nametextWhen the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s first name. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank.
Referring Provider Middle Initialreferring_provider_middle_initialtextWhen the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s middle initial. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank.
Referring Provider Credentialsreferring_provider_credentialstextWhen the referring provider is registered in NPPES as an individual (entity type code=’I’), these are the referring provider’s credentials. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank.
Referring Provider Genderreferring_provider_gendertextWhen the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s gender. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank.
Referring Provider Entity Codereferring_provider_entity_codetextType of entity reported in NPPES. An entity code of ‘I’ identifies referring providers registered as individuals and an entity type code of ‘O’ identifies referring providers registered as organizations.
Referring Provider Street 1referring_provider_street_1textThe first line of the referring provider’s street address, as reported in NPPES.
Referring Provider Street 2referring_provider_street_2textThe second line of the referring provider’s street address, as reported in NPPES.
Referring Provider Cityreferring_provider_citytextThe city where the referring provider is located, as reported in NPPES.
Referring Provider Statereferring_provider_statetextThe state where the referring 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'
Referring Provider Zipreferring_provider_ziptextThe referring provider’s zip code, as reported in NPPES.
Referring Provider Countryreferring_provider_countrytextThe country where the referring 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’; ‘IL’= Israel’; ‘AR’= ‘Argentina’; ‘IN’= India’; ‘AU’= ‘Australia’; ‘IS’= Iceland; ‘BR’= ‘Brazil’; ‘IT’= Italy’; ‘CA’= ‘Canada’; ‘JP’= Japan’; ‘CH’= Switzerland’; ‘KR’= ‘Korea’; ‘CN’= China’; ‘NL’= ‘Netherlands’; ‘CO’= Colombia’; ‘PK’= ‘Pakistan’; ‘DE’= ‘Germany’; ‘SA’= ‘Saudi Arabia’; ‘ES’= ‘Spain’; ‘SY’= ‘Syria’; ‘FR’= France’; ‘TR’= ‘Turkey’; ‘GB’= Great Britain’; ‘VE’= ‘Venezuela’; ‘HU’= Hungary’
Referring Provider Typereferring_provider_typetextDerived from the Medicare provider/supplier specialty code reported on all of the NPI's Part B non-institutional claims (DMEPOS & non-DMEPOS). For referring providers that have more than one Medicare specialty code reported on their claims, the Medicare specialty code associated with the largest number of services was used. Where a prescriber's NPI did not have associated Part B claims, the taxonomy code associated with the NPI in NPPES was mapped to a Medicare specialty code using an external crosswalk published here: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Taxonomy.html. For any taxonomy codes that could not be mapped to a Medicare specialty code, the taxonomy classification description was used.
Referring Provider Type Flagreferring_provider_type_flagtextA flag variable that indicates the source of the Referring Provider Type: "S" = Medicare Specialty Code description "T" = Taxonomy Code Classification description
Number of Suppliersnumber_of_suppliersnumberNumber of suppliers rendering products/services billed through DMEPOS MACs.
Number of Supplier HCPCSnumber_of_supplier_hcpcsnumberTotal number of unique DMEPOS product/service hcpcs codes billed by suppliers and ordered by the referring provider.
Number of Supplier Beneficiariesnumber_of_supplier_beneficiariesnumberTotal number of unique beneficiaries associated with DMEPOS claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries.
Number of Supplier Claimsnumber_of_supplier_claimsnumberTotal number of DMEPOS claims submitted by suppliers, reflecting products/services ordered by the referring provider.
Number of Supplier Servicesnumber_of_supplier_servicesnumberTotal DMEPOS products/services rendered by suppliers and ordered by the referring provider.
Supplier Submitted Chargessupplier_submitted_chargesnumberThe total charges that suppliers submitted for all DMEPOS products/services ordered by the referring provider.
Supplier Medicare Allowed Amountsupplier_medicare_allowed_amountnumberThe Medicare allowed amount for all DMEPOS products/services ordered by the referring provider. 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.
Supplier Medicare Payment Amountsupplier_medicare_payment_amountnumberAmount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's DMEPOS line item products/services ordered by the referring provider.
Supplier Medicare Standard Payment Amountsupplier_medicare_standard_payment_amountnumberAmount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for all supplier’s durable medical equipment line item products/services and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual product/services and makes Medicare payments across geographic areas comparable. Note: This variable is available starting with the calendar year 2014 data.
Durable Medical Equipment (DME) Suppression Indicatordurable_medical_equipment_dme_suppression_indicatortextA 1-byte value which defines the suppression, if needed, of the utilization, charge and payment information associated with durable medical equipment HCPCS codes. A value of '*' means the suppressed information is based on a dme-specific claim count of 1 through 10. A value of '#' means the dme-specific information has been counter-suppressed. Counter-suppression is needed when the display of dme-specific data could be used to recalculate suppressed values in non-dme-specific columns.
Number of Durable Medical Equipment (DME) Suppliersnumber_of_durable_medical_equipment_dme_suppliersnumberNumber of suppliers rendering durable medical equipment products/services.
Number of Durable Medical Equipment (DME) HCPCSnumber_of_durable_medical_equipment_dme_hcpcsnumberTotal number of unique durable medical equipment hcpcs codes billed by suppliers and ordered by the referring provider.
Number of Durable Medical Equipment (DME) Beneficiariesnumber_of_durable_medical_equipment_dme_beneficiariesnumberTotal number of unique beneficiaries associated with durable medical equipment claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries.
Number of Durable Medical Equipment (DME) Claimsnumber_of_durable_medical_equipment_dme_claimsnumberTotal number of durable medical equipment claims submitted by suppliers, reflecting services ordered by the referring provider.
Number of Durable Medical Equipment (DME) Servicesnumber_of_durable_medical_equipment_dme_servicesnumberTotal durable medical equipment products/services rendered by suppliers and ordered by the referring provider.
Durable Medical Equipment (DME) Submitted Chargesdurable_medical_equipment_dme_submitted_chargesnumberThe total charges that suppliers submitted for all durable medical equipment products/services ordered by the referring provider.
Durable Medical Equipment (DME) Medicare Allowed Amountdurable_medical_equipment_dme_medicare_allowed_amountnumberThe Medicare allowed amount for all durable medical equipment products/services ordered by the referring provider. 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.
Durable Medical Equipment (DME) Medicare Payment Amountdurable_medical_equipment_dme_medicare_payment_amountnumberAmount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's durable medical equipment line item products/services ordered by the referring provider.
Durable Medical Equipment (DME) Medicare Standard Payment Amountdurable_medical_equipment_dme_medicare_standard_payment_amountnumberAmount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for all supplier’s durable medical equipment line item products/services and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual product/services and makes Medicare payments across geographic areas comparable. Note: This variable is available starting with the calendar year 2014 data.
Prosthetic and Orthotic (PO) Suppression Indicatorprosthetic_and_orthotic_po_suppression_indicatortextA 1-byte value which defines the suppression, if needed, of the utilization, charge and payment information associated with prosthetic and orthotic HCPCS codes. A value of '*' means the suppressed information is based on a prosthetic and orthotic-specific claim count of 1 through 10. A value of '#' means the prosthetic and orthotic-specific information has been counter-suppressed. Counter-suppression is needed when the display of prosthetic and orthotic-specific data could be used to recalculate suppressed values in non-prosthetic and orthotic-specific columns.
Number of Prosthetic and Orthotic (PO) Suppliersnumber_of_prosthetic_and_orthotic_po_suppliersnumberNumber of suppliers rendering prosthetic and orthotic products/services.
Number of Prosthetic and Orthotic (PO) HCPCSnumber_of_prosthetic_and_orthotic_po_hcpcsnumberTotal number of unique prosthetic and orthotic hcpcs codes billed by suppliers and ordered by the referring provider.
Number of Prosthetic and Orthotic (PO) Beneficiariesnumber_of_prosthetic_and_orthotic_po_beneficiariesnumberTotal number of unique beneficiaries associated with prosthetic and orthotic claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries.
Number of Prosthetic and Orthotic (PO) Claimsnumber_of_prosthetic_and_orthotic_po_claimsnumberTotal number of prosthetic and orthotic claims submitted by suppliers, reflecting products/services ordered by the referring provider.
Number of Prosthetic and Orthotic (PO) Servicesnumber_of_prosthetic_and_orthotic_po_servicesnumberTotal prosthetic and orthotic products/services rendered by suppliers and ordered by the referring provider.
Prosthetic and Orthotic (PO) Submitted Chargesprosthetic_and_orthotic_po_submitted_chargesnumberThe total charges that suppliers submitted for all prosthetic and orthotic products/services ordered by the referring provider.
Prosthetic and Orthotic (PO) Medicare Allowed Amountprosthetic_and_orthotic_po_medicare_allowed_amountnumberThe Medicare allowed amount for all prosthetic and orthotic products/services ordered by the referring provider. 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.
Prosthetic and Orthotic (PO) Medicare Payment Amountprosthetic_and_orthotic_po_medicare_payment_amountnumberAmount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's prosthetic and orthotic line item products/services ordered by the referring provider.
Prosthetic and Orthotic (PO) Medicare Standard Payment Amountprosthetic_and_orthotic_po_medicare_standard_payment_amountnumberAmount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for all supplier’s prosthetic and orthotic line item products/services and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual product/services and makes Medicare payments across geographic areas comparable. Note: This variable is available starting with the calendar year 2014 data.
Drug and Nutritional Suppression Indicatordrug_and_nutritional_suppression_indicatortextA 1-byte value which defines the suppression, if needed, of the utilization, charge and payment information associated with drug and nutritional HCPCS codes. A value of '*' means the suppressed information is based on a drug and nutritional-specific claim count of 1 through 10. A value of '#' means the drug and nutritional-specific information has been counter-suppressed. Counter-suppression is needed when the display of drug and nutritional-specific data could be used to recalculate suppressed values in non-drug and nutritional-specific columns.
Number of Drug and Nutritional Products Suppliersnumber_of_drug_and_nutritional_products_suppliersnumberNumber of suppliers rendering drug and nutritional products/services.
Number of Drug and Nutritional Products HCPCSnumber_of_drug_and_nutritional_products_hcpcsnumberTotal number of unique drug and nutritional product hcpcs codes billed by suppliers and ordered by the referring provider.
Number of Drug and Nutritional Products Beneficiariesnumber_of_drug_and_nutritional_products_beneficiariesnumberTotal number of unique beneficiaries associated with drug and nutritional product claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries.
Number of Drug and Nutritional Products Claimsnumber_of_drug_and_nutritional_products_claimsnumberTotal number of drug and nutritional product claims submitted by suppliers, reflecting services ordered by the referring provider.
Number of Drug and Nutritional Products Servicesnumber_of_drug_and_nutritional_products_servicesnumberTotal drug and nutritional products/services rendered by suppliers and ordered by the referring provider.
Drug and Nutritional Products Submitted Chargesdrug_and_nutritional_products_submitted_chargesnumberThe total charges that suppliers submitted for drug and nutritional products/services ordered by the referring provider.
Drug and Nutritional Products Medicare Allowed Amountdrug_and_nutritional_products_medicare_allowed_amountnumberThe Medicare allowed amount for drug and nutritional products/services ordered by the referring provider. 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.
Drug and Nutritional Products Medicare Payment Amountdrug_and_nutritional_products_medicare_payment_amountnumberAmount that Medicare paid suppliers after deductible and coinsurance amounts have been deducted for drug and nutritional line item products/services ordered by the referring provider.
Drug and Nutritional Products Medicare Standard Payment Amountdrug_and_nutritional_products_medicare_standard_payment_amountnumberAmount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for all supplier’s drug and nutritional line item products/services and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual product/services and makes Medicare payments across geographic areas comparable. Note: This variable is available starting with the calendar year 2014 data.
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.