National Provider Identifier (NPI) Data

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:<br/>• What are the locations and provider details of Clinical Social Workers who<br/>accept Medicare in New Orleans?<br/>• What is the provider’s primary specialty?<br/>• How many Public Health clinics that accept Medicare are located in Maryland?<br/>• What entities did a practitioner reassign benefits to?Sample columns from PECOS data offering:

1. PECOS Quarterly Enrollment:<br/>--SRC_NPI VARCHAR (National Provider Identifier (NPI))<br/>--SRC_PECOS_ASCT_CNTL_ID VARCHAR (PECOS Associate Control ID)<br/>--SRC_ENRLMT_ID VARCHAR (Enrollment ID)<br/>--SRC_PROVIDER_TYPE_CD VARCHAR (Provider type)<br/>--SRC_PROVIDER_TYPE_DESC VARCHAR (Provider type description)<br/>--SRC_STATE_CD VARCHAR (State code)<br/>--SRC_FIRST_NAME VARCHAR (Provider first name)<br/>--SRC_MDL_NAME VARCHAR (Provider middle name)<br/>--SRC_LAST_NAME VARCHAR (Provider last name)<br/>--SRC_ORG_NAME VARCHAR (Organization name)<br/>
2. Practice Location List Table<br/>--SRC_ENRLMT_ID VARCHAR (Enrollment ID)<br/>--SRC_CITY_NAME VARCHAR (City name where practice is located)<br/>--SRC_STATE_CD VARCHAR (State code where practice is located)<br/>--SRC_ZIP_CD VARCHAR (Zip code where practice is located.

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The Centers for Medicare & Medicaid Services (CMS) established the National Plan and Provider Enumeration System (NPPES) to assign standard unique identifiers for health care providers and plans in compliance with The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information.<br/>With Sparksoft's comprehensive NPPES data offerings, you are able to ask relevant population health questions such as:

1. How many OBGYN’s are present in the New Orleans area?
2. What is the phone number and primary practice address for each provider in Washington, DC?
3. What is the specialty/ taxonomy of a particular practice?

***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:-NPI List (Weekly and Monthly): This Contains all of the FOIA-disclosable active provider data in NPPES. For the weekly NPI, each week new data is added containing only the new FOIA-disclosable NPPES provider data since the last weekly or monthly file was generated.-Deactivated NPI List (Weekly and Monthly): This table contains all deactivated NPIs with their NPI deactivation date.-Monthly Endpoint List (Weekly and Monthly): This file contains all Endpoints associated with Type 1 and Type 2 NPIs.-Monthly Other name List (Weekly and Monthly): This table contains monthly additional Other Names associated with Type 2 NPIs.-Practice Location List (Non-primary practice locations): Each line in the Practice Location Reference File represents a Practice Location Address associated with an NPI Record. The NPIDATA_LST (Weekly and Monthly) contains the first Primary Practice Location, and the PRACTICELOCATION_LST (Weekly and Monthly) contain all of the non-primary Practice Locations.***Key Metadata Tables:<br/>-File Load Log: This table contains the metadata for each loaded file<br/>-Parameter Table: Enhancements for each column and data dictionary<br/>-Data Profile Report: Profile per for each file by column<br/>-Table Details: Table description and background information on the data.

Definitions and descriptions taken from the documentation linked below.

搜集汇总

背景与挑战

背景概述

该数据集基于PECOS和NPPES系统，收录了美国各类医疗保险注册提供者的基本信息，如NPI编码、专业类型和执业地点等。它适用于人口健康分析、公共健康研究等领域，支持对医疗保险提供者分布情况的查询与分析。