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)

A list of practitioners who have opted out of Medicare.*

Source: Provider Enrollment, Chain and Ownership System (PECOS) as of January 31st, 2019

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.

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.
For more information, see https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2011.html.

This file is a point in time snapshot of enrollment level data for providers actively enrolled in Medicare.

The file contain the National Provider Identifier (NPI) and legal name (last name, first name) of those physicians and non-physician practitioners that are eligible to order and refer PMD and have a current enrollment record in Medicare.
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8239.pdf

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. CMS has completed its initial round of revalidations and will be resuming regular revalidation cycles in accordance with 42 CFR §424.515. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements one of which is established due dates by which you must revalidate.

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.

CPT copyright 2014 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/use-agreement/cpt-code/medicare-provider-data-2015

NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers.

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 administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2015 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

CPT copyright 2014 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/use-agreement?id=ee7f-sh97

NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers.
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 administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

Testing the efficacy of the patient-centered medical home among Federally Qualified Health Centers (FQHCs).

This crosswalk links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the appropriate Healthcare Provider Taxonomy Codes. This crosswalk includes the Medicare Specialty Codes for those provider/supplier types who have Medicare Specialty Codes. The Healthcare Provider Taxonomy Code Set is available from the Washington Publishing Company (www.wpc-edi.com) and is maintained by the National Uniform Claim Committee (www.nucc.org). The code set is updated twice a year, with the updates being effective April 1 and October 1 of each year. This document reflects Healthcare Provider Taxonomy Codes effective for use on April 2, 2018.

When changes are made to Medicare provider enrollment requirements, the Medicare Specialty Codes, or the Healthcare Provider Taxonomy Code Set, this document may need to be revised.

NOTE: This document does not alter existing Medicare claims preparation, processing, or payment instructions, nor does it alter existing Medicare provider enrollment requirements or policies.

CPT copyright 2014 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/use-agreement?id=jzd2-pt4g

NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers.

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.

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.

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.

[Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.

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).

Note: Data descriptions are available in the Data Dictionary on the ACOs in Your State webpage at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/ACOs-in-Your-State.html. Look for the Downloads section at the bottom of the page and open the ZIP file to see the Data Dictionary.

DISCLAIMER: This information is current as of February 2016. Changes to ACO information occurs periodically. Each ACO has the most up-to-date information about their organization. Consider using them as a resource to obtain the latest information about an ACO.

This dataset presents data on Performance Year 1 final financial reconciliation and quality performance results for ACOs with 2012 and 2013 agreement start dates. Performance year 1 is a 21- or 18-month period for ACOs with 2012 start dates, and a 12 month period for ACOs with 2013 start dates. ACOs that generated savings earned a performance payment if they met the quality standard. For the first Performance Year, CMS defined the quality performance standard as complete and accurate reporting for all quality measures. Quality performance for Performance Year 1 reconciliation for ACOs with 2012 start dates is based on complete and accurate reporting of all required quality measures for Calendar Years 2012 and 2013. Quality performance for Performance Year 1 reconciliation for ACOs with 2013 start dates is based on complete and accurate reporting of all required quality measures for Calendar Year 2013. The quality performance results provided in the Performance Year 1 announcement reflect Calendar Year 2013 performance rates for 220 ACOs.

Notes:
1 - (Gross) Generated savings: Total savings (first to last dollar) for ACOs whose savings equaled or exceeded their minimum savings rates (variable based on ACO size under Track 1 and flat 2% under Track 2). This amount does not account for the application of the ACO’s final sharing rate based on quality performance, reduction due to sequestration or repayment of advance payments.
2 - (Gross) Generated losses: Total losses (first to last dollar) for Track 2 ACOs whose losses equaled or exceeded their minimum loss rate (flat 2%). This amount does not account for the application of the ACO’s final sharing rate based on quality performance.
3 - Total earned shared savings: The ACO’s share of savings for ACOs whose savings equaled or exceeded their minimum savings rates, and who were eligible for a performance payment because they met the program’s quality performance standard. This amount accounts for the application of the ACO’s final sharing rate based on quality performance (50% under Track 1 and 60% under Track 2 for PY1), as well as the reduction in performance payment due to sequestration. This amount does not account for repayment of advance payments.
4 - Total earned shared losses: The ACO’s share of losses for Track 2 ACOs whose losses equaled or exceeded their minimum loss rate (flat 2%). This amount accounts for the application of the ACO’s final loss sharing rate (which does not exceed 60%) based on quality performance.
N/A = Not Available
5 - Successfully Reported Quality: ACOs are considered to have successfully reported quality if they completely reported in both 2012 and 2013. ACOs who did not successfully report in 2013 will not have performance rates for GPRO Web Interface measures displayed.
6 - ACO-11 performance rate unavailable: No providers eligible for this measure due to measure's inclusion/exclusion criteria.
7 - Performance rate unavailable: No beneficiaries eligible for this measure due to the measure's inclusion/exclusion criteria.
8 - Performance rate unavailable: ACO did not satisfactorily report in 2013.
* ACO did not successfully report in the first reporting period (2012) but did successfully report in their second reporting period (2013).
^Measures marked with a caret (^) are measures where a lower performance rate is indicative of better quality.
For a crosswalk of ACO measure numbers to ACO measure names, please consult the following table: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-Shared-Savings-Program-Quality-Measures.pdf.

Disclaimer – This information is current as of October 2014. Updates to the website will be made annually based on final performance year financial reconciliation and quality results.

Based upon Medicare Shared Savings Program Accountable Care Organizations Performance Year 2015 Results

This dataset presents data on Calendar Year 2015 financial reconciliation and quality performance results for ACOs with 2012, 2013, 2014 and 2015 agreement start dates. ACOs that generated savings earned a performance payment if they met the quality standard.

Notes: 1 - (Gross) Generated savings: Total savings (first to last dollar) for ACOs whose savings equaled or exceeded their minimum savings rates (variable based on ACO size under Track 1 and flat 2% under Track 2). This amount does not account for the application of the ACO’s final sharing rate based on quality performance, reduction due to sequestration or repayment of advance payments (for ACOs participating in the Advance Payment model and ACO Investment Model, AIM). 2 - (Gross) Generated losses: Total losses (first to last dollar) for Track 2 ACOs whose losses equaled or exceeded their minimum loss rate (flat 2%). This amount does not account for the application of the ACO’s final sharing rate based on quality performance. 3 - Earned shared savings: The ACO’s share of savings for ACOs whose savings equaled or exceeded their minimum savings rates (variable based on ACO size under Track 1 and flat 2% under Track 2), and that were eligible for a performance payment because they met the program’s quality performance standard. This amount accounts for the application of the ACO’s final sharing rate based on quality performance (up to 50% under Track 1 and up to 60% under Track 2), as well as the reduction in performance payment due to sequestration. This amount does not account for repayment of advance payments. 4 - Owed losses: The ACO’s share of losses for Track 2 ACOs whose losses equaled or exceeded their minimum loss rate (flat 2%). This amount accounts for the application of the ACO’s final loss sharing rate (which does not exceed 60%) based on quality performance. 5 - Met the Quality Performance Standard: An ACO must meet the quality performance standard to be eligible to share in any savings generated. For the 2015 performance year, any ACO that did not completely report quality data did not meet the quality performance standard. The quality performance standard for ACOs with 2015 start dates that are in their first performance year is based on complete and accurate reporting of all required quality measures for Calendar Year 2015. ACOs beyond the first performance year of their first agreement period must also meet minimum attainment (which is ≥30% or ≥30th percentile benchmark) on at least one Pay for Performance measure in each domain in order to meet the quality performance standard. 6 - Quality Score: ACOs with 2015 start dates will have a “P4R” (Pay for Reporting) displayed for the Quality Score to reflect that their quality performance is based on complete and accurate reporting.

^ - Measures marked with a caret (^) are measures where a lower performance rate is indicative of better quality.

ACOs that did not successfully report CAHPS measures in 2015 will have a dash "-" displayed for CAHPS measures (ACO-1 through ACO-7 and ACO-34). ACOs that did not successfully report GPRO Web Interface measures in 2015 will have a dash "-" displayed for GPRO Web Interface measures (ACO-13 through ACO-33 and ACO-39 through ACO-41). These measure fields appear as blank cells in the downloaded file (the dash is not displayed).

For measures ACO-13 through ACO-33 and ACO-39 through ACO-41, if no beneficiaries were eligible for this measure due to the measure's inclusion/exclusion criteria, then an "N/A" (Not Applicable) will appear in the place of a performance rate.

For a crosswalk of ACO measure numbers to ACO measure names and for more information on how the Quality Score was determined for ACOs with an Agreement Start Date in 2012, 2013, 2014, or 201