CarePrecise Access^™ State Databases

Relational Key

The NPI is a unique 10-digit numerical code assigned to every HIPAA-covered healthcare provider, including individuals and organizations, by the U.S. Department of Human Services, Centers for Medicare and Medicaid Services (CMS).

The federal data contains variations on state codes, abbreviations and full state names; we conform this field to standard 2-character state codes where possible.

The federal data contains variations on state codes, abbreviations and full state names; we conform this field to standard 2-character state codes where possible.

Type 1 indicates an individual provider (i.e., physician, psychologist, etc.); Type 2 indicates an organizational provider (i.e., hospital, lab, pharmacy, etc.)

For Type 2 providers, may be one of several organizational units, each with its own NPI number

CMS is not yet providing tax numbers of this type

Y= provider is enrolled in PECOS (eligible to bill Medicare); N = not enrolled. Uppercase Y indicates exact NPI match in PECOS history; lowercase y indicates algorithmic match without historical verification.

From the Office of Inspector General's excluded providers database (LEIE). A warning in this field should not be taken as definitive; the user should check the tExcluded table and consider other sources of provider fraud and exclusion information. (Algorithmically derived*).

Y= elements in the providers record indicated a match with a listing in the federal excluded providers database (see the table tExcluded below)

The exclusion type from the LEIE database, explaining the reason that a provider was barred from billing Medicare. Fields with a Y in the Warning field will display this code.

The code's definition can be found at this link. A CSV file listing these exclusion descriptions is included in the CarePrecise Access Complete CSV download file.

Y= this provider reported that it operates as either a multi-specialty group or single-specialty group.

Name of the provider's authorizing official, if other than the listed individual provider. For organizations, this is the contact name.

(Provider organization names, esp. Type 2 providers; MDB and CSV formats)

(Provider phone and fax numbers; MDB and CSV formats)

(Provider Taxonomy codes indicating specialties and subspecialties for Type 1/individual providers, and facility types for Type 2/organization providers; MDB and CSV formats)

The number of the NPPES taxonomy field (1 through 15)

The source data (NPPES) permits group codes to be reported in up to 15 fields in this section. CarePrecise creates a 1-to-many table, listing each of a provider's reported txonomy group codes in a separate record. The Gnum is the NPPES Group Taxonomy field number in which the code was reported, allowing the code be matched with the specific group specialty in the tTaxo table. For instance, a code in tTaxoGroup field Gnum 3 indicates a group practice of the specialty reported in Tnum 3 in the tTaxo table.

This is the newest of the data released by CMS in the NPPES file. This is where the group taxonomy codes are reported. CMS does not report the codes in the taxonomy section (which appear in our tTaxo table) because they represent an additional layer of information on any one or more of the tTaxo codes.

193200000X for a multi-specialty practice
193400000X for a single-specialty practice

Provider co-location code (algorithmically derived*). The NPI and CoLoCode comprise the dual relational key for this table. The NPI identifies the provider record, and the CoLoCode identifies the co-located group. The CoLoCode is an up to 40-character string that stands in for detailed location data, and is not intended to be sensical to the human viewer. The CoLoCode /Group Practice system is in beta and subject to change, although code assignment per location is designed to remain static month-to-month (i.e., a given practice group's code would remain the same from month-to-month, while members' codes would change as they move to different practice groups) unless the group's location changes, as the code is predicated on practice location.

This code is an algorithmically derived conformation of the provider's practice location, permitting identification of providers who practice at the same location, for instance, physician groups, dental groups, radiology groups, etc. By using this table in conjunction with the tTaxoGroups table, it is possible to visualize the group entity (generally an organization) and its provider members.

Although each provider should have only one primary practice location in our database, technically, the tCoLoCode table is 1-to-many, because our system may not be able to resolve a single practice location per provider. There may be up to two distinct CoLoCodes for some providers.

Count of providers matching this co-location (algorithmically derived conformation of the provider's practice location; see tCoLoCodes above). Indicates the number of providers practicing at this co-location.

(MDB and CSV formats)

(MDB and CSV formats)

The CarePrecise processing date on which it was discovered that the provider record was dropped from the NPPES database. Corresponds to the most recent previous CMS update date on which the provider data was dropped from the NPPES database.

Type 1 is individual providers (i.e., physicians, psychologists, etc.); Type 2 is organizational providers (i.e., hospitals, labs, etc.)

This is a generated field based on EntityType.

The federal data contains variations on state codes, abbreviations and full state names; we conform this field to standard 2-character state codes. A small number of non-US postal addresses remain nonconforming.

tExcluded

This table, sourced from the LEIE, lists all provider records in the federal excluded providers database. A provider may be excluded (barred from billing Medicare) for reasons of a criminal nature, among other reasons. This table contains no relational key; however, it is used to produce the Warning field in the tEntity table, which does include the provider's NPI. This table should be referenced for backup information.

Additional data tables:

• Names
• Names_Company
• Names_Cred
• Names_Generize
• Names_Prefices
• Names_Suffices
• StateNameVariants

(These tables are included only in CarePrecise Gold; MDB format)

* Algorithmically derived data in the CPAC dataset includes data that is extracted/mined from the source databases, but which has a margin of error and should not be relied upon as conclusive. Record linking algorithms are used to enrich our data when direct correlation (via a unique identifier field) is not available, using available information in name, address, phone, taxonomy, and other fields. In particular, the data on providers excluded from billing Medicare (from the federal LEIE database) can only be linked to NPI records by this means. In like manner, the available federal data does not provide information on providers' practice groups; using record-linkage technology, we can extrapolate the groups assuming that providers sharing the same practice location are members of the group reported at that location, and these group data can be corroborated or enriched with the group practice codes provided by CMS.