Medicare Physicians and Other Suppliers Utilization And Payment Data Aggregate Report
Medicare Beneficiaries Utilization, Payment And Charges Physician and Other Suppliers Aggregate Report
Medicare Physicians and Other Suppliers Utilization, Payment Data Demographic And Health Characteristics Aggregate Report
Medicare and Medicaid Entitlement, Physicians and Other Suppliers data, Chronic Conditions And Risk scores Aggregate Report
Keywords
National Provider Identity
Aggregate Report
Medical Type Services
Drug Type Services
Utilization and Payment Data
Demographic and Health Characteristics
Medicare and Medicaid Entitlement
Chronic Conditions
Average Risk Scores
Medicare NPI Physician And Other Supplier Payment Aggregate Report
The dataset contains information on utilization and payments (Total submitted charges, Medicare allowed amount, Medicare Payment amount, Medicare standardized payment amount) organized by National Provider Identity. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges.
John Snow Labs Standard End User License Agreement
Last updated:January 20, 2021
This Standard End User License Agreement (“EULA”) applies to customers of John Snow Labs Inc. (as defined below), using any product of John Snow Labs Inc. on John Snow Labs Marketplace as defined below (hereinafter referred to “you”) and John Snow Labs Inc., a Delaware corporation (“John Snow Labs”, “we” or “us”).
By downloading, installing, and/or using (as applicable) any Product of John Snow Labs (as defined below), you automatically agree to be bound by, and use our Products in compliance with, this EULA. This EULA, together with additional terms and conditions and/or policies referenced herein or located on https://www.johnsnowlabs.com and/or conveyed to you by John Snow Labs, is a legally binding contract between you and John Snow Labs.
PLEASE READ THIS EULA CAREFULLY BEFORE PURCHASING, INSTALLING OR USING OUR PRODUCTS MADE AVAILABLE ON JOHN SNOW LABS MARKETPLACE.
We may make changes to this EULA from time to time. When we do so, we will revise the “last updated” date given above. The then-current version of this EULA will supersede all earlier versions. You agree that your continued use of our Products after such changes have been published to our EULA will constitute your acceptance of such revised EULA.
“Products” means products and services of John Snow Labs that you download and use from listings in John Snow Labs Data Library;
Important Notice
By installing and using our Products, you acknowledge that the use of the Products can be subject to the restrictions and controls imposed by United States export regulations.
You represent and warrant that you do not intend to use the Products for any purpose prohibited by United States export regulations, including, without limitation, terrorism, cyber-attacks, cyber-crimes, money-laundering, industrial espionage, or nuclear, chemical or biological weapons proliferation. Further, you represent and warrant that you are not listed as a denied party on any list governing United States exports.
Eligibility
Our Products can be used by an individual, business or other legal entity, or both. If you are entering into this EULA, or using the Products, on behalf of a company or other legal entity, you represent that you have the authority to bind such entity to this EULA, in which case “you” shall refer to such entity.
In the event you have entered into a separate written agreement with John Snow Labs regarding the Products that contemplates terms that are inconsistent with this EULA, the written agreement shall control and this EULA will not apply to you to the extent inconsistent with such written agreement, or, if such written agreement is contemplated to be in lieu of this EULA, then this EULA shall not apply at all.
Your Access and Use
Subject to your compliance with this EULA, as well as any other applicable policies, John Snow Labs grants you non-exclusive, non-transferable, license to install, access to, modify, and use of, the Products worldwide (subject to applicable export laws) during the term of this EULA (as described below) solely for research, private study and personal use of Products.
This license is personal to you, and you may not resell our Products, permit other users access to our Products through your account. Your right to use our Products is limited by all terms and conditions set forth in this EULA.
Except for your pre-existing rights and this license granted to you, we and our licensors retain all rights, titles and interests in and to our Products, all related intellectual property rights, including trademarks (whether registered or pending), domain and business names. Our Products are protected by applicable intellectual property laws, including United States copyright law and international treaties.
Except for the foregoing license, you have no other rights in the Products and you may not modify, edit, copy, reproduce, create derivative works of, reverse engineer, alter, enhance or in any way exploit the Products in any manner. If you breach any of this EULA, the above license will terminate automatically.
You will be deemed to have taken any action that you permit, assist or facilitate any person or entity to take related to this EULA, your content or use of the Products. You are responsible for end users’ use of your content and the Products. You will ensure that all end users comply with your obligations under this EULA and that the terms of your agreement with each end user are consistent with this EULA. If you become aware of any violation of your obligations under this EULA caused by an end user, you will immediately suspend access to your content and the Products by such end user. We do not provide any support or services to end users unless we have a separate agreement with you or an end user obligating us to provide such support or services.
Restrictions
You will access or use our Products solely via John Snow Labs Data Library.
Except as otherwise explicitly provided in this EULA or as may be expressly permitted by applicable law, you will not, and will not permit or authorize any third party to:
reproduce, modify, translate, enhance, decompile, disassemble, reverse engineer or create derivative works of any of our Products or its technological features or measures;
rent, lease, sell, resell, loan, distribute, or sublicense access to any of our Products;
circumvent or disable any security or technological features or measures of our Products;
use our intellectual property rights without our express prior written authorization;
use our Products for more than one trial period, unless the trial period is extended by John Snow Labs’ prior written permit;
use our Products with an intent to build a competitive product or service, or copy or substantially copy any ideas, features, functions, organization, structure, application program interface, graphics, or user interface of the Products;
store, copy, modify, distribute, or resell any of the information; audio, visual, and audiovisual works, or other content made available on our Products (collectively, “Content”) or compile or collect any Content as part of a database or other work;
use any automated tool (e.g., robots, spiders) to access or use our Products, or to store, copy, modify, distribute, or resell any Content;
circumvent or disable any rights management, usage rules, or other security features of our Products;
use our Products in a manner that overburdens, or that threatens the integrity, performance, or availability of, our Products; or
remove, alter, or obscure any proprietary notices (including copyright and trademark notices) on any portion of our Products or any Content.
Fees and Taxes
Your use of the Products is subject to our fees. All fees are given on our website https://www.johnsnowlabs.com. Except as set forth in this EULA, the fees are non-refundable. We are entitled to revise our fees from time to time.
The fees exclude any federal, state or local taxes, VAT, GST, or similar taxes. You are responsible for identification and payment of all taxes as required by applicable law.
Term and Termination
This EULA will become effective as of the date of your order of Products and shall be in effect until terminated.
John Snow Labs may suspend or terminate your right to use our Products, if you or your end user’s use of the Products:
is in breach of this EULA;
poses a security risk to our Products;
could adversely impact our systems, the Products or other customers;
could subject us, our affiliates, or any third party to liability; or
could be fraudulent.
We may also suspend or terminate your right to use our Products, if you fail to perform your payment obligations, or you have ceased to operate in the ordinary course, made an assignment for the benefit of creditors or similar disposition of your assets, or become the subject of any bankruptcy, reorganization, liquidation, dissolution or similar proceeding.
We may also suspend or terminate your right to use our Products without any reason upon a relevant 30 days’ written notice to you and will refund the unused fees pre-paid by you for access to the Products for the affected time period (if any). Where your access is suspended or terminated by the breach of this EULA or applicable laws, John Snow Labs will will not provide, or be liable for, any refund.
You will cease use of the Products during any period of suspension, or upon termination of this EULA.
All provisions which by their nature are intended to survive termination shall survive termination of this EULA.
Support
If applicable to your Product, John Snow Labs will provide you with the support services. If you use a trial access, support services are excluded. Under this EULA, our support services exclude any installation, training, maintenance services (including any error corrections, bug fixes, or new releases), technical assistance, consulting services, or other services of any kind. Such services are provided at John Snow Labs’ discretion.
From time to time John Snow Labs can perform updates to our software. If available, such updates may include bug fixes, new features and/or enhancements. You are solely responsible for deploying such updates at your own risk and liability.
Access to our Products
We do not provide you with the equipment to access our Products. You are responsible for all fees charged by third parties related to your access and use of our Products (e.g., charges by Internet service providers).
You are responsible for monitoring your use of the Products, including payment of all fees and/or taxes related to such access and use. You agree that John Snow Labs is permitted to request and you hereby consent to provide John Snow Labs information related to your use of the Products for auditing purposes.
You also certify that you are legally permitted to use the Products, and take full responsibility for the selection and use of the Products. This EULA is void where prohibited by law, and the right to use the Products is revoked in such jurisdictions. John Snow Labs makes no claim that the Products may be lawfully used outside of the United States. If you use the Products from outside of the United States, you do so at your own risk and you are responsible for compliance with the laws of jurisdiction.
Privacy Policy
We may collect, store and receive personal and other information about you through our Products. Our collection and use of this information is governed by our Privacy Policy available at https://www.JohnSnowLabs.com/privacy/ which may be amended from time to time.
Links and Third Party Content
Our Products may display, or contain links to, third party products, services, and websites. Any opinions, advice, statements, services, offers, or other information that constitutes part of the content expressed, authored, or made available by other users or other third parties, or which is accessible through or may be located using our Products (collectively, “Third Party Content”) are those of the respective authors or producers and not of us or our shareholders, directors, officers, employees, agents, or representatives.
We do not control Third Party Content and do not guarantee the accuracy, integrity or quality of such Third Party Content. We are not responsible for the performance of, we do not endorse, and we are not responsible or liable for, any Third Party Content or any information or materials advertised in any Third Party Content. By using our Products, you may be exposed to content that is offensive, indecent, or objectionable. We are not responsible or liable, directly or indirectly, for any damage or loss caused to you by your use of or reliance on any goods, services, or information available on or through any third party service or Third Party Content. It is your responsibility to evaluate the information, opinion, advice, or other content available on and through our Products.
Proprietary Rights
John Snow Labs will not obtain any rights under this EULA from you (or your licensors) to your content.
The Products, including software, is and remains the exclusive property of John Snow Labs and its licensors. Except for the access and use rights expressly set forth in this EULA, no license or other rights in or to the Products or John Snow Labs trademark(s) and other intellectual property rights therein, are granted to you, and all such licenses and rights are expressly reserved. You will not remove, alter, or obscure any proprietary notices (including copyright and trademark notices) on any portion of our Products or any Content.
Trademarks
“John Snow Labs,” the John Snow Labs logo, and any other product, business or service name or slogan, whether registered or pending, displayed on our Products are trademarks of John Snow Labs, Inc. or its suppliers or licensors, and may not be copied, imitated or used, in whole or in part, without the prior written permission of John Snow Labs or the applicable trademark holder. You may not use any metatags or any other “hidden text” utilizing “John Snow Labs” or any other name, trademark or product, business or service name of John Snow Labs without our prior written permission. In addition, the look and feel of our Products, including all page headers, custom graphics, button icons and scripts, is the service mark, trademark and/or trade dress of John Snow Labs and may not be copied, imitated or used, in whole or in part, without our prior written permission. All other trademarks, pending trademarks, registered trademarks, product names and company names or logos mentioned in our Products are the property of John Snow Labs Inc. and/or their respective owners. Reference to any products, services, processes or other information, by trade name, trademark, manufacturer, supplier, or otherwise does not constitute or imply endorsement, sponsorship, or recommendation thereof by us.
Disclaimer of Warranties
YOUR USE OF THE PRODUCTS IS AT YOUR SOLE RISK. THE PRODUCTS AND CONTENT EACH ARE PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS. WE AND OUR SUPPLIERS AND LICENSORS EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NON-INFRINGEMENT. WE DO NOT GUARANTEE THE ACCURACY, COMPLETENESS, OR USEFULNESS OF THE PRODUCTS OR ANY CONTENT, AND YOU RELY ON THE PRODUCTS AND CONTENT AT YOUR OWN RISK. ANY MATERIAL THAT YOU ACCESS OR OBTAIN THROUGH OUR PRODUCTS IS DONE AT YOUR OWN DISCRETION AND RISK AND YOU WILL BE SOLELY RESPONSIBLE FOR ANY DAMAGE TO YOUR COMPUTER OR LOSS OF DATA THAT RESULTS FROM THE DOWNLOAD OF ANY MATERIAL THROUGH OUR PRODUCTS. NO ADVICE OR INFORMATION, WHETHER ORAL OR WRITTEN, OBTAINED BY YOU FROM US OR THROUGH OR FROM OUR PRODUCTS WILL CREATE ANY WARRANTY NOT EXPRESSLY STATED IN THIS EULA. SOME STATES MAY PROHIBIT A DISCLAIMER OF WARRANTIES AND YOU MAY HAVE OTHER RIGHTS THAT VARY FROM STATE TO STATE.
Limitation of Liability
WE AND OUR SUPPLIERS AND LICENSORS WILL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR EXEMPLARY DAMAGES, INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS, GOODWILL, USE, DATA, OR OTHER INTANGIBLE LOSSES (EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF THESE DAMAGES), RESULTING FROM YOUR USE OF OUR PRODUCTS AND CONTENT. UNDER NO CIRCUMSTANCES WILL THE TOTAL LIABILITY OF US AND OUR SUPPLIERS AND LICENSORS OF ALL KINDS ARISING OUT OF OR RELATED TO YOUR USE OF THE PRODUCTS AND CONTENT (INCLUDING BUT NOT LIMITED TO WARRANTY CLAIMS), REGARDLESS OF THE FORUM AND REGARDLESS OF WHETHER ANY ACTION OR CLAIM IS BASED ON CONTRACT, TORT, OR OTHERWISE, EXCEED THE AMOUNTS, IF ANY, THAT YOU HAVE PAID FOR YOUR USE OF THE PRODUCTS AND CONTENT. BECAUSE SOME STATES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, THE ABOVE LIMITATION MAY NOT APPLY TO YOU.
Indemnity
To the full extent permitted by applicable law, you shall defend, indemnify and hold harmless John Snow Labs, its affiliates and its licensors, and each of their respective employees, officers, directors, and representatives from and against any claims, damages, losses, liabilities, costs, and expenses (including reasonable attorney’s fees) arising out of or relating to any third party claim concerning: (a) your use of the Products; (b) breach of this EULA or violation of applicable law by you; (c) any content or the combination of such content with other software, content or processes, including any claim involving alleged infringement or misappropriation of third-party rights by such content or combination; or (d) breach of any obligation or duty you owe to a third party.
Legal Notices
Enforcement of this EULA will be governed by the laws of the State of Delaware, excluding its conflict and choice of law principles. The exclusive jurisdiction and venue for any claims arising out of or related to this EULA or your use of the Products will lie in the state and federal courts located in Sussex County, within the State of Delaware, and you irrevocably agree to submit to the jurisdiction of such courts. Our failure to enforce any right or provision in this EULA will not constitute a waiver of such right or provision unless acknowledged and agreed by us in writing. In the event that a court of competent jurisdiction finds any provision of this EULA to be illegal, invalid, or unenforceable, the remaining provisions will remain in full force and effect.
Notifications
We may use your contact information to notify you if we have any legitimate interest or if we need to notify you on any important information related to your use of Products. We will not send you newsletters unless you expressly consented to such notifications.
Contacting Us
If you have any questions or concerns about our Products or this EULA, you may contact us by email at support@JohnSnowLabs.com.
The Physician and Other Supplier Public Use File contains information on utilization, payment (Total submitted charges, Medicare allowed amount, Medicare Payment amount, Medicare standardized payment amount) organized by National Provider Identifier (NPI)and Healthcare Common Procedure Coding System (HCPCS) code. The data in the Physician and Other Supplier PUF is from physician/supplier Part B non-institutional line items for the Medicare fee-for-service (FFS) population. Claims processed by Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS) Medicare Administrative Contractor (MAC) are not included in the Physician and Other Supplier PUF. The 2015 data are available from the Centres for Medicaid and Medicare Services (CMS) Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For all Physician and Other Supplier PUF data years, provider demographics (name, credentials, gender, complete address and entity type) are taken from the National Plan & Provider Enumeration System (NPPES). CMS developed the NPPES to assign unique identifiers, known as National Provider Identifiers (NPIs), to health care providers. The demographic information provided in the 2015 Physician and Other Supplier PUF was extracted from NPPES at the end of the calendar year 2015.
The spending and utilization data in the Physician and Other Supplier PUF are aggregated to the following:
a) the NPI for the performing provider,
b) the Healthcare Common Procedure Coding System (HCPCS) code, and
c) the place of service (either facility or non-facility).
There can be multiple records for a given NPI based on the number of distinct HCPCS codes that were billed and where the services were provided. Data have been aggregated based on the place of service because separate fee schedules apply depending on whether the place of service submitted on the claim is facility or non-facility. The Physician and Other Supplier PUF and the supplemental summary tables including the “Medicare Physician and Other Supplier Aggregate Table” (i.e., one record per NPI) have been updated to include Medicare standardized payment amounts. The “Medicare Physician and Other Supplier Aggregate Table” (i.e., one record per NPI) have the Average beneficiary risk scores which provide information on the health status of the beneficiaries the providers serve. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores. NPI Physician And Other Supplier Payment Aggregate Report from 2012 to 2015 is merged here.
About this Dataset
Data Info
Date Created
2017-02-15
Last Modified
2019-06-05
Version
2019-06-05
Update Frequency
Annual
Temporal Coverage
2017
Spatial Coverage
United States
Source
John Snow Labs; Centers for Medicare And Medicaid Services;
Source License URL
Source License Requirements
N/A
Source Citation
N/A
Keywords
National Provider Identity, Aggregate Report, Medical Type Services, Drug Type Services, Utilization and Payment Data, Demographic and Health Characteristics, Medicare and Medicaid Entitlement, Chronic Conditions, Average Risk Scores
Other Titles
Medicare Physicians and Other Suppliers Utilization And Payment Data Aggregate Report, Medicare Beneficiaries Utilization, Payment And Charges Physician and Other Suppliers Aggregate Report, Medicare Physicians and Other Suppliers Utilization, Payment Data Demographic And Health Characteristics Aggregate Report, Medicare and Medicaid Entitlement, Physicians and Other Suppliers data, Chronic Conditions And Risk scores Aggregate Report
Data Fields
Name
Description
Type
Constraints
National_Provider_Identifier
National Provider Identifier (NPI) for the performing provider on the claim. The provider NPI is the numeric identifier registered in NPPES.
integer
level : Nominal
Last_Name_Of_The_Provider_Or_Organization
When 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.
string
-
First_Name_Of_The_Provider
When 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.
string
-
Middle_Initial_Of_The_Provider
When 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.
string
-
Credentials_Of_The_Provider
When 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
string
-
Gender_Of_The_Provider
When 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.
string
-
Entity_Type_Of_The_Provider
Type 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.
string
-
Street_Address_1_Of_The_Provider
The first line of the provider’s street address, as reported in NPPES.
string
-
Street_Address_2_Of_The_Provider
The second line of the provider’s street address, as reported in NPPES.
string
-
City
The city where the provider is located, as reported in NPPES. The ARMY areas were divided into three Military "States": AA - Armed Forces Americas, AE - Armed Forces Europe, AP - Armed Forces Pacific. Those States are divided into three "Cities": APO - Army Post Office, FPO - Fleet Post Office, DPO - Diplomatic Post Office
string
-
Zip_Code
The provider’s zip code, as reported in NPPES.
string
-
Provider_RUCA
The provider’s Rural-Urban Commuting Area Codes (RUCAs) based on zip code. RUCAs are a Census tract-based classification scheme that utilizes the standard Bureau of Census Urbanized Area and Urban Cluster definitions in combination with work commuting information to characterize all of the nation's Census tracts regarding their rural and urban status and relationships.
number
level : Ratio
State_Abbreviation
The 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.
string
-
Country_Code_Of_The_Provider
The country where the provider is located, as reported in NPPES. The country code will be ‘US’ for any state or U.S. possession.
string
-
Specialty_Type_Of_The_Provider
Derived 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.
string
-
Is_Medicare_Participation_Indicator
Identifies whether the provider participates in Medicare and/or accepts assignment of Medicare allowed amounts. The value will be ‘true’ for any provider that had at least one claim identifying the provider as participating in Medicare or accepting assignment of Medicare allowed amounts within HCPCS code and place of service. A non-participating provider may elect to accept Medicare allowed amounts for some services and not accept Medicare allowed amounts for other services.
boolean
-
Number_Of_HCPCS
Total number of unique HCPCS codes.
integer
level : Ratio
Number_Of_Services
Total provider services.
number
level : Ratio
Number_Of_Medicare_Beneficiaries
Total 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.
number
level : Ratio
Total_Submitted_Charge_Amount
The total charges that the provider submitted for all services.
number
-
Total_Medicare_Allowed_Amount
The 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.
number
-
Total_Medicare_Payment_Amount
Total amount that Medicare paid after deductible and coinsurance amount have been deducted for all the provider's line-item services.
number
-
Total_Medicare_Standardized_Payment_Amount
Total 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.
number
-
Drug_Suppress_Indicator
Identifies 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.
string
-
Number_Of_HCPCS_Associated_With_Drug_Services
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File
integer
level : Ratio
Number_Of_Drug_Services
Total drug services, as defined from the Medicare Part B Drug ASP File.
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.
integer
level : Ratio
Total_Drug_Submitted_Charge_Amount
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.
number
-
Total_Drug_Medicare_Allowed_Amount
The 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.
number
-
Total_Drug_Medicare_Payment_Amount
Total amount that Medicare paid after deductible and coinsurance amount have been deducted for all the provider's line-item drug services, as defined from the Medicare Part B Drug ASP File.
number
-
Total_Drug_Medicare_Standardized_Payment_Amount
Total 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.
number
-
Medical_Suppress_Indicator
Identifies whether the utilization, cost and payment information associated with HCPCS codes for Medical (non-ASP) services have been suppressed.
string
-
Number_Of_HCPCS_Associated_With_Medical_Services
Total number of HCPCS codes associated with medical (non-ASP) services.
Total Medicare beneficiaries receiving medical (non-ASP) services.
integer
level : Ratio
Total_Medical_Submitted_Charge_Amount
The total charges that the provider submitted for medical (non-ASP) services.
number
-
Total_Medical_Medicare_Allowed_Amount
The 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.
number
-
Total_Medical_Medicare_Payment_Amount
Total amount that Medicare paid after deductible and coinsurance amount have been deducted for all of the provider's line item medical (non-ASP) services.
Total 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.
number
-
Average_Age_Of_Beneficiaries
Average age of beneficiaries. Beneficiary age is calculated at the end of the calendar year or at the time of death.
integer
level : Ratio
Number_Of_Beneficiaries_Age_Less_65
Number of beneficiaries under the age of 65. Beneficiary age is calculated at the end of the calendar year or at the time of death.
integer
level : Ratio
Number_Of_Beneficiaries_Age_65_To_74
Number 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.
integer
level : Ratio
Number_Of_Beneficiaries_Age_75_To_84
Number 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.
integer
level : Ratio
Number_Of_Beneficiaries_Age_Greater_Than_84
Number of beneficiaries over the age of 84. Beneficiary age is calculated at the end of the calendar year or at the time of death
integer
level : Ratio
Number_Of_Female_Beneficiaries
Number of female beneficiaries
integer
level : Ratio
Number_Of_Male_Beneficiaries
Number of male beneficiaries.
integer
level : Ratio
Number_Of_Non_Hispanic_White_Beneficiaries
Number of non-Hispanic white beneficiaries.
integer
level : Ratio
Number_Of_Black_Or_African_American_Beneficiaries
Number of non-Hispanic black or African American beneficiaries
Number 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 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 meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia.
integer
level : Ratio
Percent_Of_Beneficiaries_Identified_With_Asthma
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma.
integer
level : Ratio
Percent_Of_Beneficiaries_Identified_With_Cancer
Percent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer.
Percent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders.
integer
level : Ratio
Percent_Of_Beneficiaries_Identified_With_Stroke
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke.
integer
level : Ratio
Average_HCC_Risk_Score_Of_Beneficiaries
Average Hierarchical Condition Category (HCC) risk score of beneficiaries. CMS developed a risk-adjustment model that uses HCCs (hierarchical condition categories) to assign risk scores. Those scores estimate how beneficiaries’ FFS spending will compare to the overall average for the entire Medicare population. The average risk score is set at 1.08; beneficiaries with scores greater than that are expected to have above-average spending, and vice versa.
number
level : Ratio
Data Preview
National Provider Identifier
Last Name Of The Provider Or Organization
First Name Of The Provider
Middle Initial Of The Provider
Credentials Of The Provider
Gender Of The Provider
Entity Type Of The Provider
Street Address 1 Of The Provider
Street Address 2 Of The Provider
City
Zip Code
Provider RUCA
State Abbreviation
Country Code Of The Provider
Specialty Type Of The Provider
Is Medicare Participation Indicator
Number Of HCPCS
Number Of Services
Number Of Medicare Beneficiaries
Total Submitted Charge Amount
Total Medicare Allowed Amount
Total Medicare Payment Amount
Total Medicare Standardized Payment Amount
Drug Suppress Indicator
Number Of HCPCS Associated With Drug Services
Number Of Drug Services
Number Of Medicare Beneficiaries With Drug Services
Total Drug Submitted Charge Amount
Total Drug Medicare Allowed Amount
Total Drug Medicare Payment Amount
Total Drug Medicare Standardized Payment Amount
Medical Suppress Indicator
Number Of HCPCS Associated With Medical Services
Number Of Medical Services
Number Of Medicare Beneficiaries With Medical Services
Total Medical Submitted Charge Amount
Total Medical Medicare Allowed Amount
Total Medical Medicare Payment Amount
Total Medical Medicare Standardized Payment Amount
Average Age Of Beneficiaries
Number Of Beneficiaries Age Less 65
Number Of Beneficiaries Age 65 To 74
Number Of Beneficiaries Age 75 To 84
Number Of Beneficiaries Age Greater Than 84
Number Of Female Beneficiaries
Number Of Male Beneficiaries
Number Of Non Hispanic White Beneficiaries
Number Of Black Or African American Beneficiaries
Number Of Asian Pacific Islander Beneficiaries
Number Of Hispanic White Beneficiaries
Number Of American Indian Alaska Native Beneficiaries
Number Of Beneficiaries With Race Not Elsewhere Classified
Number Of Beneficiaries With Medicare Only Entitlement
Number Of Beneficiaries With Medicare And Medicaid Entitlement
Percent Of Beneficiaries Identified With Atrial Fibrillation
Percent Of Beneficiaries With Alzheimers Disease Or Dementia
Percent Of Beneficiaries Identified With Asthma
Percent Of Beneficiaries Identified With Cancer
Percent Of Beneficiaries Identified With Heart Failure
Percent Of Beneficiaries Identified With Chronic Kidney Disease
Percent Of Beneficiaries With Chronic Obstructive Pulmonary Disease
Percent Of Beneficiaries Identified With Depression
Percent Of Beneficiaries Identified With Diabetes
Percent Of Beneficiaries Identified With Hyperlipidemia
Percent Of Beneficiaries Identified With Hypertension
Percent Of Beneficiaries Identified With Ischemic Heart Disease
Percent Of Beneficiaries Identified With Osteoporosis
Percent Of Beneficiaries With Rheumatoid Arthritis Osteoarthritis
Percent Of Beneficiaries With Schizophrenia Other Psychotic Disorders
Demos
