PECOS: Medicare Fee-For-Service Public Provider Enrollment

PECOS stands for Provider, Enrollment, Chain, and Ownership System. PECOS is a Medicare enrollment management system that permits individuals and entities to enroll as Medicare providers or suppliers. It's essential that providers enroll in PECOS if they wish to file Medicare claims.

Physicians and Specialists, Registered Nurses, Physician Assistants, Certified Clinical Nurse Specialists, Nurse Practitioners, Clinical Psychologists, Certified Nurse-Midwives, Clinical Social Workers, and Physicians employed by the Department of Veterans Affairs, the Public Health Service, or the Department of Defense/Tricare who wish to be a Medicare provider or supplier must enroll in PECOS.

For this reason, PECOS is an excellent resource for population health analytics, public health research, and social determinants of health research, to examine the distribution of Medicare- enrolled providers. This table includes basic enrollment and provider information including National Provider Identifier (NPI), provider type code, reassignment of benefits information and practice location city, state, and zip.

Using the PECOS data, you can answer questions such as:
• What are the locations and provider details of Clinical Social Workers who
accept Medicare in New Orleans?
• What is the provider’s primary or secondary specialty?
• How many Public Health clinics that accept Medicare are located in Maryland?
• What entities did a practitioner reassign benefits to?

***Included in the share is 4 data tables with built in data dictionaries (shown below), as well as 4 metadata tables with information about source data, load frequency, and data demographics:

-PECOS Quarterly Enrollment List- This file contains a unique listing of all provider enrollment applications that have been approved to bill or order and refer in Medicare. The enrollment ID (ENRLMT_ID) is the unique number assigned by PECOS to identify provider enrollment applications. This enrollment ID field is used to link between the four data files included in the PPEF. This file contains the National Provider Identifier (NPI) associated with the enrollment and the PECOS-assigned identifier, PECOS Associate Control ID or PAC ID, which is used to identify enrolling providers. This file also includes the type of provider, name, and gender.

-PECOS Quarterly Reassignment List- This file contains a unique listing of enrollment ID pairs of individual providers reassigning their benefits and providers receiving the reassignment of benefits. The practitioner enrollment ID that is reassigning benefits is given in the REASGN_BNFT_ENRLMT_ID field. The enrollment ID of the entity receiving the reassignment of benefits is given in the RCV_BNFT_ENRLMT_ID field. This file can be linked to the ENROLLMENT file using either of these enrollment ID fields.

PECOS Quarterly Practice Location List- This file contains a unique listing of practice location city, state, and zip code for each enrollment. This file can be linked to the ENROLLMENT file using enrollment ID.

-PECOS Quarterly Secondary Specialty List – This file contains a unique listing of enrollment ID and secondary specialty information pairs, for practitioner and DME supplier enrollments. This file can be linked to the ENROLLMENT file using enrollment ID.

Sample columns from PECOS data offering:
1. PECOS Quarterly Enrollment:
--SRC_NPI VARCHAR (National Provider Identifier (NPI))
--SRC_PECOS_ASCT_CNTL_ID VARCHAR (PECOS Associate Control ID)
--SRC_ENRLMT_ID VARCHAR (Enrollment ID)
--SRC_PROVIDER_TYPE_CD VARCHAR (Provider type)
--SRC_PROVIDER_TYPE_DESC VARCHAR (Provider type description)
--SRC_STATE_CD VARCHAR (State code)
--SRC_FIRST_NAME VARCHAR (Provider first name)
--SRC_MDL_NAME VARCHAR (Provider middle name)
--SRC_LAST_NAME VARCHAR (Provider last name)
--SRC_ORG_NAME VARCHAR (Organization name)

2. Practice Location List Table
--SRC_ENRLMT_ID VARCHAR (Enrollment ID)
--SRC_CITY_NAME VARCHAR (City name where practice is located)
--SRC_STATE_CD VARCHAR (State code where practice is located)
--SRC_ZIP_CD VARCHAR (Zip code where practice is located)

Sparksoft’s comprehensive Medicare Fee-For-Service Public Provider Enrollment data offerings inform your data-driven decisions and allow you to ask critical population health management questions. We are now offering analytic ready, Centers for Medicare & Medicaid Services (CMS) data sets as part of our mission is to facilitate access to public CMS data.

We are happy to expand this data offering to include any additional public data asset our customers would like us to maintain.

Definitions and descriptions taken from the documentation linked below.

搜集汇总

背景与挑战

背景概述

该数据集包含医疗保险按服务收费公共提供者注册系统(PECOS)的四类核心数据表，涵盖提供者注册信息、福利重新分配记录、执业地点及次要专业资质，支持医疗保险提供者分布分析和公共卫生研究。数据通过唯一注册ID关联，包含NPI编号、提供者类型、执业城市/州/邮编等关键字段。