Others titles
- Medicare Providers Utilization and Billing Payment Data for Physicians and Other Suppliers 2012
- Prospective Payment System 2012
- Doctor Utilization and Payment Data 2012
- Medicare Doctors and Providers Utilization and Payment Data 2012
- Medicare Billing and Providers Utilization and Payment Data for Physicians and Other Suppliers 2012
- Doctors Pay and Medicare Providers Utilization and Payment Data 2012
Keywords
- Medicare Doctors
- Medicare Claim
- Physician Services
- Medicare Physicians
- Medicare Find a Doctor
- Medicare Providers
- National Claims History (NCH)
- Medicare Billing
- Physician Services
- Doctors Pay
Utilization and Payment Data Physician and Other Supplier 2012
The dataset contains information on ‘Provider Utilization and Payment Data Physician and Other Supplier Public Use File (PUF)’ prepared by the Centers for Medicare & Medicaid Services (CMS) and organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System code, and place of service. This PUF is based on information from CMS’s National Claims History (NCH) Standard Analytic Files (SAFs).
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Description
This dataset from CMS has information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The primary data source for this dataset is CMS’s National Claims History (NCH) Standard Analytic Files (SAFs). The Centers for Medicare and Medicaid Services (CMS) collects data from all hospitals that provide services to Medicare beneficiaries on an ongoing basis through its fiscal intermediaries, and compiles the data for each calendar year. The Physician/Supplier SAF was used to create the Physician and Other Supplier PUF, which includes services from physicians, non-physician practitioners, laboratories, imaging, ambulances, etc. Information on utilization and payments (Average submitted charges, Average Medicare allowed amount, Average Medicare Payment amount, Medicare standardised payment amount)on NPI is included here. It includes a detailed information on Physicians, Number of services and Number of HCPCS handled by physicians. The number of services, providers, uniques beneficiaries, per day services on uniques beneficiaries are also included. Standard deviation of Medicare allowed amount, Submitted charge amount and Medicare Payment amount is included in 2012 dataset.
About this Dataset
Data Info
Date Created | 2014-03-23 |
---|---|
Last Modified | 2017-09-23 |
Version | 2017-09-23 |
Update Frequency |
Annual |
Temporal Coverage |
2012 |
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 | Medicare Doctors, Medicare Claim, Physician Services, Medicare Physicians, Medicare Find a Doctor, Medicare Providers, National Claims History (NCH), Medicare Billing, Physician Services, Doctors Pay |
Other Titles | Medicare Providers Utilization and Billing Payment Data for Physicians and Other Suppliers 2012, Prospective Payment System 2012, Doctor Utilization and Payment Data 2012, Medicare Doctors and Providers Utilization and Payment Data 2012, Medicare Billing and Providers Utilization and Payment Data for Physicians and Other Suppliers 2012, Doctors Pay and Medicare Providers Utilization and Payment Data 2012 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
National_Provider_Identifier | National Provider Identifier (NPI) for the performing provider on the claim. | integer | level : Nominal |
Last_Name_Organization_Name_Of_The_Provider | Last Name/Organization Name of the provider; 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 | 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 | 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 | 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 | 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 | Entity code 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 | 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 | Street Address 2 of the Provider: The second line of the provider’s street address, as reported in NPPES. | string | - |
City_Of_The_Provider | City of the Provider: The city where the provider is located, as reported in NPPES. | string | - |
Zip_Code_Of_The_Provider | Zip Code of the Provider: The provider’s zip code, as reported in NPPES. | string | - |
State_Code_Of_The_Provider | State Code of the Provider: The state where the provider is located, as reported in NPPES. | string | - |
Country_Code_Of_The_Provider | Country Code of the Provider: The country where the provider is located, as reported in NPPES. | string | - |
Specialty_Type_Of_The_Provider | Provider 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 | Medicare Participation Indicator: Identifies whether the provider participates in Medicare and/or accepts assignment of Medicare allowed amounts. | boolean | - |
Place_Of_Service | Place of Service: Identifies whether the place of service submitted on the claims is a facility (value of ‘F’) or non-facility (value of ‘O’). Non-facility is generally an office setting; however other entities are included in non-facility. See “Appendix B – Place of Service Descriptions” for the types of entities included in facility and non-facility. | string | - |
HCPCS_Code | HCPCS Code: HCPCS code for the specific medical service furnished by the provider. | string | - |
HCPCS_Description | HCPCS Description: Description of the HCPCS code for the specific medical service furnished by the provider. | string | - |
Is_HCPCS_Drug_Indicator | HCPCS Drug Indicator: Identifies whether the HCPCS code for the specific service furnished by the provider is an HCPCS listed on the Medicare Part B Drug Average Sales Price (ASP) File. | boolean | - |
Number_Of_Services | Number of line services; note that the metrics used to count the number provided can vary from service to service. | number | level : Ratio |
Number_Of_Medicare_Beneficiaries | Number of Medicare Beneficiaries: Number of distinct Medicare beneficiaries receiving the service. | integer | level : Ratio |
Number_Of_Distinct_Medicare_Beneficiary_Per_Day_Services | Number of Distinct Medicare Beneficiary/Per Day Services: Number of distinct Medicare beneficiary/per day services. | integer | level : Ratio |
Average_Medicare_Allowed_Amount | Average Medicare Allowed Amount for the service; 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 | level : Ratio |
Standard_Deviation_of_Medicare_Allowed_Amount | Standard deviation of Medicare allowed amount: The standard deviation indicates the amount of variation from the average Medicare allowed amount that exists within a single provider, HCPCS service, and place of service. | number | level : Ratio |
Average_Submitted_Charge_Amount | Average Submitted Charge Amount: Average of the charges that the provider submitted for the service. | number | level : Ratio |
Standard_Deviation_of_Submitted_Charge_Amount | Standard deviation of submitted charge amount: Standard deviation of the charge amounts submitted by the provider. | number | level : Ratio |
Average_Medicare_Payment_Amount | Average Medicare Payment Amount: Average amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item service. | number | level : Ratio |
Standard_Deviation_of_Medicare_Payment_Amount | Standard deviation of medicare payment amount: The standard deviation indicates the amount of variation from the average Medicare payment amount that exists within a single provider, HCPCS service, and place of service. | number | level : Ratio |
Data Preview
National Provider Identifier | Last Name Organization Name Of The Provider | 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 Of The Provider | Zip Code Of The Provider | State Code Of The Provider | Country Code Of The Provider | Specialty Type Of The Provider | Is Medicare Participation Indicator | Place Of Service | HCPCS Code | HCPCS Description | Is HCPCS Drug Indicator | Number Of Services | Number Of Medicare Beneficiaries | Number Of Distinct Medicare Beneficiary Per Day Services | Average Medicare Allowed Amount | Standard Deviation of Medicare Allowed Amount | Average Submitted Charge Amount | Standard Deviation of Submitted Charge Amount | Average Medicare Payment Amount | Standard Deviation of Medicare Payment Amount |
1245225077 | RODRIGUEZ | CARLOS | M | MD | M | Individual | 315 75TH ST W | BRADENTON | 342093201 | FL | US | Internal Medicine | True | Non-facility | 83036 | Hemoglobin A1C level | False | 134 | 91 | 134 | 13.75 | 28.0 | 13.75 | ||||
1760595664 | WINGREN | MICHAEL | D | MD | M | Individual | 6718 144TH ST NW | GIG HARBOR | 983328738 | WA | US | Family Practice | True | Facility | 99308 | Subsequent nursing facility visit, typically 15 minutes per day | False | 73 | 21 | 73 | 65.99 | 92.37 | 11.62 | 49.09 | 13.33 | ||
1508805490 | JASZCZAK | TERESA | M.D. | F | Individual | 2891 E MAPLE RD | SUITE 102 | TROY | 480836106 | MI | US | Internal Medicine | True | Facility | 99238 | Hospital discharge day management, 30 minutes or less | False | 85 | 75 | 85 | 72.49 | 120.0 | 57.99 | ||||
1992706618 | CONGER | BRUCE | M | M.D. | M | Individual | 11055 LITTLE PATUXENT PKWY | SUITE103 | COLUMBIA | 210442896 | MD | US | Internal Medicine | True | Non-facility | 90732 | Vaccine for pneumococcal polysaccharide for injection into muscle, patient 2 years or older | True | 27 | 27 | 27 | 64.18 | 3.33 | 72.78 | 5.33 | 64.18 | 3.33 |
1508865726 | HUMPHREYS | ERIC | M | M.D. | M | Individual | 500 S CLEVELAND AVE | WESTERVILLE | 430818971 | OH | US | Anesthesiology | True | Facility | 01922 | Anesthesia for X-ray or radiation therapy | False | 15 | 14 | 15 | 144.16 | 38.16 | 692.27 | 254.27 | 115.33 | 30.53 | |
1528065653 | SEWCHAND | JOEL | F.A.C.P.,F.A.C.G. | M | Individual | 101 CENTENNIAL ST STE B | LA PLATA | 206465976 | MD | US | Gastroenterology | True | Facility | 45378 | Diagnostic examination of large bowel using an endoscope | False | 67 | 67 | 67 | 226.69 | 45.44 | 1562.69 | 221.65 | 181.35 | 36.35 | ||
1982656286 | PAGE | DIANA | L | DO | F | Individual | 208 JACK MARTIN BLVD | BLDG C1 | BRICK | 87247770 | NJ | US | Otolaryngology | True | Non-facility | 99203 | New patient office or other outpatient visit, typically 30 minutes | False | 29 | 29 | 29 | 98.91 | 200.0 | 72.42 | 18.96 | ||
1093797581 | PALAZZO | ETTORE | G | MD | M | Individual | 12040 NE 128TH ST | MS #105 | KIRKLAND | 980343013 | WA | US | Internal Medicine | True | Facility | 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | False | 229 | 96 | 229 | 73.48 | 142.74 | 5.35 | 57.29 | 9.13 | |
1891981346 | MARK | TOMER | MD | M | Individual | 525 E 68TH ST | NEW YORK | 100654870 | NY | US | Medical Oncology | True | Non-facility | G0364 | Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service | False | 28 | 22 | 28 | 13.73 | 325.0 | 10.98 | |||||
1003924861 | SMITH | KIMBERLY | S | M.D. | F | Individual | 4205 MCAULEY BLVD | SUITE 301 | OKLAHOMA CITY | 731208347 | OK | US | Orthopedic Surgery | True | Facility | 27447 | Repair of knee joint | False | 17 | 16 | 17 | 1263.53 | 344.75 | 4147.29 | 313.18 | 1010.82 | 275.8 |