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Medicare Part D Prescriber Look-up Tool

New prescription drug data now available. Data from the 2013 Medicare Part D Prescriber Public Use File can now be easily searched to find information on drugs prescribed by physicians and other practitioners for Medicare beneficiaries. Information available include drug name, number of prescriptions dispensed (including original prescriptions and refills) and drug cost.
Medicare Physician and Other Supplier Look-up Tool

Updated data for 2013 now available. Quickly find information on services and procedures delivered by a provider, including average payments for those services, by entering the provider name and/or location.

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1.	Order and Referring Order and Referring Medicare order and referring 11202015 Order and Referring data file has National Provider Identifier (NPI) and legal name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS)	299,514 views
2.	Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) - FY2011 Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) - FY2011 Medicare medicare, cms, health care providers, inpatient, ... 6/2/14 UPDATE: Original FY2011 data file has been updated to include a new column, "Average Medicare Payment." The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent more than 7 million discharges or 60 percent of total Medicare IPPS discharges.	136,272 views
3.	Comprehensive Care for Joint Replacement Model: Metropolitan Statistical Areas (MSAs) Comprehensive Care for Joint Replacement Model: Metropolitan Statistical Areas (MSAs) This data set presents Metropolitan Statistical Areas (MSAs) that are participating in the Comprehensive Care for Joint Replacement Model, a proposed model to support better and more efficient care for beneficiaries undergoing the most common inpatient surgery for Medicare beneficiaries: hip and knee replacements.	106,580 views
4.	Therapy Provider Phase Information Therapy Provider Phase Information npi, phase, therapy, manual medical review The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for manual medical review of therapy claims.	64,145 views
5.	FQHC Advanced Primary Care Practice Demonstration Participants FQHC Advanced Primary Care Practice Demonstration Participants Government Testing the efficacy of the patient-centered medical home among Federally Qualified Health Centers (FQHCs).	56,834 views
6.	Medicare Individual Provider List Medicare Individual Provider List part d prescriber enrollment file last updated 10/... In an effort to prepare the prescribers and Part D sponsors for the June 1, 2016, enforcement date, CMS is making available an enrollment file that identifies physician and eligible professional who are enrolled in Medicare in an approved or opt out status. The file contains production data but is considered a test file since the Part D prescriber enrollment requirement is not yet applicable. An updated enrollment file will be generated every two weeks and continue through the June 1, 2016 enforcement date. The file displays provider eligibility as of and after November 1, 2014 (i.e., currently enrolled, new approvals, or changes from opt-out to enrolled as of November 1, 2014). Any inactive providers or periods of inactivity for existing providers prior to November 1, 2014, will not be displayed on the enrollment file. However, any enrollments that become inactive after November 1, 2014, will be on the file with its respective end dates for that given provider. For opted out providers, the opt out flag will display a Y/N (Yes/No) value to indicate the periods the provider was opted out of Medicare. The file will include the provider’s: • National Provider Identifier (NPI); • First and Last Name; • Effective and End Dates; and • Opt Out Flag	50,169 views
7.	Medicare Provider Utilization and Payment Data: Physician and Other Supplier CY2012 Medicare Provider Utilization and Payment Data: Physician and Other Supplier CY2012 Medicare physician, medicare, provider, utilization, ... CPT copyright 2011 American Medical Association. All Right Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/license/39850170be6b9df17a30b99cb61849a5 NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers. As part of the Obama Administration’s efforts to make our healthcare system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS’s National Claims History (NCH) Standard Analytic Files (SAFs). The data in the Physician and Other Supplier PUF covers calendar year 2012 and contains 100% final-action (i.e., all claim adjustments have been resolved) physician/supplier Part B non-institutional line items (excluding durable medical equipment) for the Medicare fee-for-service (FFS) population.	31,693 views
8.	Monthly Pre-Existing Condition Insurance Plan Enrollment (State by State) Monthly Pre-Existing Condition Insurance Plan Enrollment (State by State) Health pcip, health care, pre-existing conditions, ... The Affordable Care Act created the new Pre-Existing Condition Insurance Plan (PCIP) program to make health insurance available to Americans denied coverage by private insurance companies because of a pre-existing condition. Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a lack of coverage for millions. The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. To learn more, visit PCIP.gov or HealthCare.gov. Note: * Massachusetts and Vermont are guarantee issue states that have already implemented many of the broader market reforms included in the Affordable Care Act that take effect in 2014. Existing commercial plans offering guaranteed coverage at premiums comparable to PCIP are already available in both states.	30,709 views
9.	Medicare Shared Savings Program Accountable Care Organizations - Map Medicare Shared Savings Program Accountable Care Organizations - Map ACO aco, acos, shared savings program, ssp, ... The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). DISCLAIMER: This information is current as of January 2015. Changes to ACO information occurs periodically. As a result, we update the data twice a year. Each ACO has the most up-to-date information. Consider using them as a resource to obtain the latest information about an ACO.	26,464 views
10.	Medicare Shared Savings Program Accountable Care Organizations Medicare Shared Savings Program Accountable Care Organizations ACO aco, acos, shared savings program, ssp, ... The Medicare Shared Savings Program (or Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). DISCLAIMER: This information is current as of August 2015. Changes to ACO information occurs periodically. As a result, we update the data twice a year. Each ACO has the most up-to-date information. Consider using them as a resource to obtain the latest information about an ACO.	24,156 views

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Medicare Part D Prescriber Look-up Tool

Medicare Physician and Other Supplier Look-up Tool

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