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)

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.

***PLEASE NOTE****The file uploads from 12/14, 12/21, 12/28, 01/04 and 01/11 were posted incorrectly and 80,000~ prescribers were missing from the list due to a software glitch caused by a software upgrade. The error has since been corrected and the accurate file was uploaded on 1/19/2016
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

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.

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.

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

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

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.

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.

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.