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Others titles
- Medicare Part D Prescriber Public Use File Data 2013
- Medicare Provider Utilization And Payment Part D Prescriber Data 2013
Keywords
- Prescriber Data
- Prescription Drug Plans
- Medicare Part D
- Medicare Advantage
- Medicare Prescription Drug Coverage
- Medicare Claims Data
- Provider Summary
Medicare Part D Prescriber Utilization and Payment Data 2013
The Medicare Part D Prescriber Public Use File provides information on prescription drug events (PDEs) incurred by Medicare beneficiaries with a Part D prescription drug plan for the year 2013. The Part D Prescriber PUF is organized by National Provider Identifier (NPI) and drug name and contains information on drug utilization (claim counts and day supply) and total drug costs.
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Description
The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other healthcare providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries).
About this Dataset
Data Info
| Date Created | 2015-04-30 |
|---|---|
| Last Modified | 2017-05-25 |
| Version | 2017-05-25 |
| Update Frequency |
Annual |
| Temporal Coverage |
2013 |
| 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 | Prescriber Data, Prescription Drug Plans, Medicare Part D, Medicare Advantage, Medicare Prescription Drug Coverage, Medicare Claims Data, Provider Summary |
| Other Titles | Medicare Part D Prescriber Public Use File Data 2013, Medicare Provider Utilization And Payment Part D Prescriber Data 2013 |
Data Fields
| Name | Description | Type | Constraints |
|---|---|---|---|
| National_Provider_Identifier | National Provider Identifier (NPI) for the performing provider on the claim. | string | - |
| Last_Name_Organization_Name | When the provider is registered in NPPES as an individual, this is the provider’s last name. When the provider is registered as an organization, this is the organization name. | string | - |
| First_Name | When the provider is registered in NPPES as an individual, this is the provider’s first name. When the provider is registered as an organization, this will be blank. | string | - |
| Middle_Initial | Middle Initial of the Provider | string | - |
| Credentials | Credentials of the Provider | string | - |
| Gender | Gender of the Provider | string | - |
| Entity_Code | Entity Type of the Provider, Individual or organization | string | - |
| Street_Address_1 | Street Address 1 of the Provider | string | - |
| Street_Address_2 | Street Address 2 of the Provider | string | - |
| City | The city where the provider is located, as reported in NPPES | string | - |
| Zip_Code | Zip Code of the Provider | string | - |
| 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 | Country Code of the Provider | string | - |
| Provider_Specialty_Type | Provider Specialty Type | string | - |
| Source_Of_Provider_Specialty | Source of Provider Specialty | string | - |
| Beneficiaries_Count | The total number of unique Medicare Part D beneficiaries with at least one claim for the drug. Counts fewer than 11 are suppressed and are indicated by a blank. | integer | level : Ratio |
| Total_Claim_Count | The number of Medicare Part D claims. This includes original prescriptions and refills. Aggregated records based on total_claim_count fewer than 11 are not included in the data file. | number | level : Ratio |
| Total_Drug_Cost | The aggregate total drug cost paid for all associated claims. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. The total drug cost is based on the amounts paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers. | number | - |
| Total_Day_Supply | The aggregate number of day’s supply for which this drug was dispensed. | number | level : Ratio |
| Beneficiary_Count_Of_Age_65 | The total number of unique Medicare Part D beneficiaries age 65 and older with at least one claim for the drug. A blank indicates the value is suppressed | integer | level : Ratio |
| Supression_Reason_Of_Beneficiary_Count_Age_65 | A flag indicating the reason the bene_count_ge65 variable is suppressed. * = Primary suppressed due to bene_count_ge65 between 1 and 10. # = Counter suppressed because the “less than 65 year old” group (not explicitly displayed) contains a beneficiary count between 1 and 10, which can be mathematically determined from bene_count_ge65 and bene_count. | string | - |
| Total_Claim_Count_Age_65 | The number of Medicare Part D claims for beneficiaries age 65 and older. This includes original prescriptions and refills. A blank indicates the value is suppressed | number | level : Ratio |
| Supression_Reason_Age_65 | A flag that indicates the reason the variable is suppressed. * = Primary suppressed due to total_claim_count_ge65 between 1 and 10. # = Counter suppressed because the “less than 65 year old” group (not explicitly displayed) contains a small claim count between 1 and 10, which can be mathematically determined from the total_claim_count_ge65 and total_claim_count. | string | - |
| Total_Drug_Cost_Age_65 | The aggregate total drug cost paid for all associated claims for beneficiaries aged 65 and older. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If total_claim_count_ge65 is suppressed, this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| Total_Day_Supply_Age_65 | The aggregate number of day’s supply for which this drug was dispensed, for beneficiaries age 65 or older. If total_claim_count_ge65 is suppressed, this variable is suppressed. A blank indicates the value is suppressed. | number | level : Ratio |
| Brand_Claim_Count | Total claims of brand-name drugs, including refills. This is based on the Food and Drug Administration approval category of New Drug Application (NDA), NDA authorized generic, or Biologic License Application (BLA). A blank indicates the value is suppressed. | number | level : Ratio |
| Brand_Supression_Flag | A flag indicating the reason the brand_claim_count and brand_drug_cost variables are suppressed. * = Primary suppressed due to brand_claim_count between 1 and 10. # = Counter suppressed because the claim count from at least one of the corresponding claim count categories (generic_claim_count or other_claim_count) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value. | string | - |
| Brand_Drug_Cost | Aggregate total drug cost paid for brand-name drugs. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. This is based on the Food and Drug Administration approval category of NDA, NDA authorized generic, or BLA. If brand_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| Generic_Claim_Count | Total claims of generic drugs, including refills. This is based on the Food and Drug Administration approval category of Abbreviated New Drug Application (ANDA). A blank indicates the value is suppressed. | number | level : Ratio |
| Generic_Supression_Flag | A flag indicating the reason the generic_claim_count and generic_drug_cost variables are suppressed. * = Primary suppressed due to generic_claim_count between 1 and 10. # = Counter suppressed because the claim count from at least one of the corresponding claim count categories (brand_claim_count or other_claim_count) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value. | string | - |
| Generic_Drug_Cost | Aggregate cost paid for generic drugs. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. This is based on the Food and Drug Administration approval category of ANDA. If generic_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| Other_Claim_Count | Total claims of other drugs, including refills. This is based any other Food and Drug Administration approval categories not included in the brand or generic definitions above. A blank indicates the value is suppressed. | number | level : Ratio |
| Other_Supression_Flag | A flag indicating the reason other_claim_count and other_drug_cost variables are suppressed. * = Primary suppressed due to other_claim_count between 1 and 10. # = Counter suppressed because the claim count from at least one of the corresponding claim count categories (brand_claim_count or generic_claim_count) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value. | string | - |
| Other_Drug_Cost | Aggregate cost paid for all other drugs not classified as brand or generic. This amount includes ingredient cost, dispensing fee and sales tax. This is based any other Food and Drug Administration approval categories not included in the brand or generic definitions above. If other_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| MAPD_Claim_Count | The number of claims for beneficiaries covered by MAPD plans. A blank indicates the value is suppressed. | number | level : Ratio |
| MAPD_Supression_Flag | A flag indicating the reason the mapd_claim_count and mapd_drug_cost variables are suppressed. * = Primary suppressed due to mapd_claim_count between 1 and 10. # = Counter suppressed because the pdp_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the mapd_claim_count and total_claim_count. | string | - |
| MAPD_Drug_Cost | Aggregate cost paid for claims filled by beneficiaries in MAPD plans. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If mapd_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| PDP_Claim_Count | The number of claims for beneficiaries covered by stand-alone PDPs. A blank indicates the value is suppressed. | number | level : Ratio |
| PDP_Supression_Flag | A flag indicating the reason the pdp_claim_count and pdp_drug_cost variables are suppressed. * = Primary suppressed due to pdp_claim_count between 1 and 10. # = Counter suppressed because the mapd_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the pdp_claim_count and total_claim_count. | string | - |
| PDP_Drug_Cost | Aggregate total drug cost paid for claims filled by beneficiaries in stand-alone PDPs. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If pdp_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| LIS_Claim_Count | Total number of claims from this prescriber, including refills, for beneficiaries with a Part D low-income subsidy. A blank indicates the value is suppressed. | number | level : Ratio |
| LIS_Supression_Flag | A flag indicating the reason the lis_claim_count and lis_drug_cost variables are suppressed. * = Primary suppressed due to lis_claim_count between 1 and 10. # = Counter suppressed because nonlis_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the lis_claim_count and total_claim_count. | string | - |
| LIS_Drug_Cost | Aggregate total drug cost paid for claims for beneficiaries with a Part D low-income subsidy. This amount includes ingredient cost, dispensing fee and sales tax. If lis_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
| Non_LIS_Claim_Count | Total number of claims from this prescriber, including refills, for beneficiaries without a Part D low-income subsidy. A blank indicates the value is suppressed. | number | level : Ratio |
| Non_LIS_Supression_Flag | A flag indicating the reason the nonlis_claim_count and nonlis_drug_cost variables are suppressed. * = Primary suppressed due to nonlis_claim_count between 1 and 10. # = Counter suppressed because lis_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the nonlis_claim_count and total_claim_count. | string | - |
| Non_LIS_Drug_Cost | Aggregate total drug cost paid for claims for beneficiaries without a Part D low income subsidy. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If nonlis_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed. | number | - |
Data Preview
| National Provider Identifier | Last Name Organization Name | First Name | Middle Initial | Credentials | Gender | Entity Code | Street Address 1 | Street Address 2 | City | Zip Code | State Abbreviation | Country Code | Provider Specialty Type | Source Of Provider Specialty | Beneficiaries Count | Total Claim Count | Total Drug Cost | Total Day Supply | Beneficiary Count Of Age 65 | Supression Reason Of Beneficiary Count Age 65 | Total Claim Count Age 65 | Supression Reason Age 65 | Total Drug Cost Age 65 | Total Day Supply Age 65 | Brand Claim Count | Brand Supression Flag | Brand Drug Cost | Generic Claim Count | Generic Supression Flag | Generic Drug Cost | Other Claim Count | Other Supression Flag | Other Drug Cost | MAPD Claim Count | MAPD Supression Flag | MAPD Drug Cost | PDP Claim Count | PDP Supression Flag | PDP Drug Cost | LIS Claim Count | LIS Supression Flag | LIS Drug Cost | Non LIS Claim Count | Non LIS Supression Flag | Non LIS Drug Cost |
| 1487724134 | ABALOS | O | 702 N 13TH ST | ARTESIA | 882101166 | NM | US | Clinic/Center | T | 15 | 2307.58 | 354 | * | * | * | # | 0.0 | 0.0 | 0.0 | 0.0 | 15.0 | 2307.58 | # | * | |||||||||||||||||||||
| 1114206109 | ABBAS | KOMAIL | D.M.D. | M | I | 620 WING ST | ELGIN | 601232800 | IL | US | Dentist | T | 21 | 420.37 | 403 | # | # | 0.0 | 0.0 | # | * | * | # | * | # | ||||||||||||||||||||
| 1427392521 | ABDOU | KARAM | D.D.S | M | I | 105 CENTER CT | DANVILLE | 945061186 | CA | US | Dentist | T | 29.0 | 35 | 400.71 | 226 | # | # | * | # | 0.0 | 0.0 | # | * | * | # | |||||||||||||||||||
| 1700104056 | ABOUSAMRA | MAMDOU | M | I | 2044 CRESCENT ST | ASTORIA | 111053266 | NY | US | Podiatry | S | 15 | 385.81 | 393 | * | * | * | # | 0.0 | 0.0 | * | * | # | * | |||||||||||||||||||||
| 1609187921 | AHMAD | NAZISH | D.O | F | I | 5601 W EUGIE AVE | GLENDALE | 853041255 | AZ | US | Specialist | T | 18 | 391.24 | 462 | * | * | * | # | 0.0 | 0.0 | * | # | # | * | ||||||||||||||||||||
| 1558686055 | AHMED | AFSHAN | DDS | F | I | 227 N CENTRAL AVE | HARTSDALE | 105301803 | NY | US | Dentist | T | 11.0 | 15 | 130.3 | 149 | # | # | * | # | 0.0 | 0.0 | * | * | * | * | |||||||||||||||||||
| 1376776153 | AL-MUFTI | FAWAZ | A | MD | M | I | 710 W 168TH ST | NEW YORK | 100323726 | NY | US | Neurology | S | 21 | 1137.86 | 1026 | * | * | 0.0 | 0.0 | # | * | * | # | # | * | |||||||||||||||||||
| 1386821031 | ALAMO | JOSE | I | D.M.D. | M | I | 165 ELMHURST | STE A | KYLE | 786406396 | TX | US | Dentist | T | 19 | 404.4 | 110 | * | * | * | # | 0.0 | 0.0 | * | # | # | * | ||||||||||||||||||
| 1194955849 | ALI | HAWAA | E | O.D. | F | I | 27792 ALISO CREEK RD | SUITE B-124 | ALISO VIEJO | 926563833 | CA | US | Optometry | S | 11 | 1582.32 | 367 | * | * | * | * | 0.0 | 0.0 | * | * | * | * | ||||||||||||||||||
| 1114127693 | ALI | NOAMAN | S | MD | M | I | 9500 EUCLID AVE | CLEVELAND | 441956769 | OH | US | General Surgery | S | 16.0 | 26 | 984.7 | 617 | # | # | * | # | * | 0.0 | 0.0 | 26.0 | 984.7 | * | # |