CarePrecise Healthcare Provider Database

(Provider addresses;
MDB and CSV formats)

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).

Additional (secondary) practice locations for Type 2 providers;
MDB and CSV formats One-to-many table.

Table is not provided in custom data pulls (CarePrecise Select services).

(Provider entity and record information; MDB and CSV formats)

From the Office of Inspector General's excluded providers database (LEIE), indicatying a sanction prevents the provider from billing Medicare. 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. Up until the May 2017 release, this field was algorithmically derived for some records.*

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 date of the exclusion from the LEIE database, where reported.

tEntity-B

(Provider entity and record information; MDB and CSV formats)

Algorithmically derived* from EPGH tExtendedPhysician.GradYear and/or CPAC tEntity.EnumDate.

tEntity-C

(Market data; MDB and CSV formats)

tHumanNames

(Provider person names or contact person names; MDB and CSV formats)

tOID

(Other identifiers, such as UPIN, OSCAR, PIN, Medicaid, etc., excluding NPI and taxonomy codes; MDB and CSV formats) One-to-many table.

tOrgNames

(Provider organization names for Type 2 providers; MDB and CSV formats)

Alternative org names beyond those lited in tOrgNames; MDB and CSV formats. One-to-many table.

Table is not provided in custom data pulls (CarePrecise Select services).

(Provider phone and fax numbers; fax numbers for approx. 65% of records; 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). One-to-many table. CarePrecise also builds a Taxonomy Delta table that notes changes in providers' taxonomy codes and licenses, available separately.

tTaxoGroups

(Provider Taxonomy codes indicating group practices; MDB and CSV formats). One-to-many table.

The source data (NPPES) permits group codes to be reported in up to 15 fields in this section. CarePrecise creates a one-to-many table, listing each of a provider's reported taxonomy 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, assuming that the healthcare provider correctly filed the NPI enumeration.

NOTE: These are part of the Provider Taxonomy Code Set, but are not reported as specialty or facility codes in the tTaxo table.

tCoLoCode

(MDB and CSV formats)

Provider CoLoCode™ (co-location code, a CarePrecise algorithmically derived* exclusive). The NPI and CoLoCode comprise the dual relational key for this table. The NPI identifies the provider record, and the CoLoCode identifies the U.S. physical location. 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.

Relational Key (composite)

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. CoLoCodes are created for Practice addresses in the United States (US) and US Minor Islands (UM).

Count of provider records reporting the specific practice location associated with this NPI number in the tAddresses table. Count includes both Type 1 (indivisual practitioners) and Type 2 (organization/facility) records.

Y = provider reports being either a Single Specialty Practice Group or Multi-specialty Practice Group or both (see the TaxoGroup table).

Number of individual practitioners (Type 1 NPI records) found co-located with this group.

(MDB and CSV formats)

Relational Key (composite)

The CarePrecise processing date on which the added provider record was discovered. Corresponds to the most recent previous CMS update date on which the added provider data was included in the NPPES database. Unduplicative index key is dual; NPI and DateDiscovered.

tDropped

CPAC records only. Table is not provided in custom data pulls (CarePrecise Select services)

(MDB and CSV formats)

Relational Key (composite)

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. Unduplicative index key is dual; NPI and DateDiscovered.

(MDB and CSV formats; CPAC records only; the CSV version of the table is named UpdatedCurrent). Table is not provided in custom data pulls (CarePrecise Select services).

This data is created by CarePrecise and is used to indicate which records in the current data release were added (a) with this release, or were updated (u) with new information with this release.

Relational Key (composite)

Added records may have actually been "added back" if they had been deactivated at an earlier data and then reactivated with the current release. This table refers only to the current month's data release, compared to the previous month's data release.

(MDB and CSV formats) Table is not provided in custom data pulls (CarePrecise Select services)

(MDB and CSV formats; CPAC records only) Table is not provided in custom data pulls (CarePrecise Select services)

Relational Key (composite)

This data is provided by CMS, listing all NPI records that have been deactivated and the deactivation date. Unduplicative index key is dual; NPI and DeactDate. Please note that a record may be added to the Deactivated tables, but then later be reactivated. Also note that Type 2 records (organizations) may have multiple records; some may be deactivated while others are active. When a record is reactivated it will appear in the tAdded table.

(Microsoft Access MDB format only; CPAC records only) Table is not provided in custom data pulls (CarePrecise Select services)

This table includes providers who may have retired or deceased.

(The EPGH is available optionally as a bundle with CarePrecise Access Complete (CPAC) that provides additional information on healthcare professionals (particularly physicians), practice groups and hospitals, and reveals the affiliation links between all three. MDB and CSV formats.)

Only active providers (defined as having appeared on a Medicare claim in the past twelve months) are included in the EPGH dataset (unlike the CPAC dataset, which includes all US HIPAA-covered providers). EPGH data is available for approximately 640,000 physicians, and 650,000 other professionals, and is growing. The hospital data in EPGH provides an unduplicated listing of hospitals and their highest priority NPI number, and is linked to each hospital's affiliated professionals/physicians and practice groups. EPGH practice group data makes it possible to see the multiple locations at which an individual provider practices.

Link to professional's data in the CPAC databases above. This ID is unique per professional (physician, PA, etc.).

Link to practice group affiliations through the tExtended_GroupProfessional table, and is a link to upcoming practice group quality data.

Unique ID for the individual professional enrollment that is the source for the data in the record. One professional may have multiple records in this table as a result of multiple PECOS enrollments, each of which may have its own hospital and practice group affiliations.

All four secondary specialties reported by the individual professional in this PECOS enrollment record, separated by commas

(Extended Practice Group information; MDB and CSV formats)

Links Group and Individual records within Extended tables. This ID is unique to each practice group.

Links practice groups in Extended tables to CPAC data above. Algorithmically derived*; not available for all group records.

Use the GroupPracPACID to link individuals with their groups through the tExtended_GroupProfessional table.

(Many-to-Many table linking group practices with individual professionals. One or more individuals per group, and may be one or more groups per individual. Extended information on group practices' individual providers, incl. whether accepts Medicare assignment, participates in various federal medical quality programs. MDB and CSV formats). Many-to-many table.

Link to individual's data in CPAC tables above and in tExtended_Professional table. This ID is unique to the individual professional.

Link between practice groups and their members in the tExtended_Professional table. This ID is unique to the practice group.

Participates in the eRx Incentive Program, a pay-for-reporting program to encourage physicians, other providers to use electronic prescribing of medications.

(Extended information on all U.S. acute care, VA and children's hospitals. Data provides a single unique NPI number per hospital facilitating deduplication of hospital record. MDB and CSV formats)

NEW: Now includes more affiliated healthcare facility data for all types of clinicians/professionals as reported by CMS.

In the EPGH dataset, the term "Hospital" is applied loosely to a range of medical facilities with which clinicians are affiliated, so that these affiliations may be more broadly included. The FacilityType field specifically indicates the facilities that are conventionally considered hospitals.

Link between hospitals and their affiliated individual physicians, etc. This ID is unique to each hospital recognized in the CMS PECOS system. If a hospital is eligible to bill Medicare (whether or not sanctioned), and is a general hospital (Acute Care, VA, Critical Access or Children's hospital), it is in this table.

This key links to the exhaustive federal hospital quality data, optionally available for download at no cost to EPGH users.

Link to one of the hospital's records in CPAC tables above. Hospitals may have as many NPI numbers as they believe they need for their particular business circumstances, and tend to have many. We have listed here the Priority NPI, based on the hierarchical Taxonomy coding system, selecting first the NPI of the record containing the top (parent) taxonomy code for the hospital type, and, if not present, the NPI from the first-listed record for the hospital. Algorithmically derived*; not available for all hospital records.

(1-to-Many table linking Hospitals with physicians and other providers; up to five hospitals per individual; MDB and CSV formats.) Many-to-many table.

NEW: Now includes more affiliated healthcare facility data for all types of clinicians/professionals as reported by CMS. This includes not only hospitals per se, but also Skilled Nursing Facilities (SNF/nursing homes), long term care facilities, rehabilitation facilities, dialysis centers, hospices, and home health care agencies that have affiliated professionals.

Link to hospital details in tExtended_Hospital via CCN, and to the CarePrecise Authoritative Hospital Database (APD)

Link to Individual Professionals affiliated with hospital

HospAffLBN

Legal business name of hospital where individual professional provides service

(Properly cased names from CPAC tHumanNames and tOrgNames tables.)

Link to data in the CPAC and EPGH databases above.

(Properly cased Mailing Addresses from CPAC tAddresses table.)

Link to data in the CPAC and EPGH databases above.

(Properly cased Practice Addresses from CPAC tAddresses table.)

Link to data in the CPAC and EPGH databases above.

APD_Physician

APD_Physician_Type2

APD_Specialty

APD_Group

Physicians' affiliated practice groups. May be up to five per physician. Ongoing extraction from Medicare claims data.

NOTE: Medical procedure performed per group can be viewed as a summary of procedures performed by each group's affiliated physicians. See example query in AuthoritativePhysicianDB.mdb.

APD_GroupAff

APD_Hospital

Physician's affiliated hospitals. May be up to five per physician. Ongoing extraction from Medicare claims data.

In the APD and EPGH datasets, the term "Hospital" is loosely applied to a range of medical facilities, so that physicians' facility affiliations can be more broadly included.

APD_HospitalAff

APD_PhysicianProcedure

Physician procedure volumes, primary procedures performed by physician, and counts of services and patients served, from CMS-collected reporting.

Procedures include the CMS Clinician Utilization data release, in compliance with copyright, and the procedure code field name will be changed to Proc_Code. For the complete procedure report, user may review and download at this link.

APD_ProcedureDescriptions

Lookup_ExclusionDescriptions

tAPD_PhysicianDMEPOS

DME (durable medical equipment) orders submitted by physician.

tAPD_PhysicianDMEPOS

Physician Durable Medical Equipment order volumes. Ongoing extraction from CMS-collected reporting. Abbreviated descriptions.

Data related to a particular hospital.

Link to data in the EPGH databases above.

Link to data in the CPAC and EPGH databases above. Algorithmically derived*; not available for all AHD records. The contact name fields in the AHD are then populated from the matched NPI record.

Economic and social segmentation data for providers' service areas.

Lat/Long of the center of the Zip Code, not rooftop. For rooftop lat/long data, see HealthGeo™ for highly accurate address-level geocodes.

Geographic longitude to 5-digit zip accuracy (center of Zip)

- Names
- Names_Company
- Names_Cred
- Names_Genderize
- Names_Prefices
- Names_Suffices
- StateNameVariants

* Marked above by an asterisk (*), algorithmically derived data in the datasets 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, some of the older data on providers excluded from billing Medicare (from the HHS Office of Inspector General's excluded providers database) can only be linked to NPI records by this means. Please note that when matches are found, there may be instances where an individual or firm has the same or similar name and location information as an excluded provider but is actually a different party. Therefore, it is important that you verify a potential match with the debarring agency identified in the record information. See the disclaimer appearing at the bottom of the documentation page.

Not all fields in all records are populated with data. Healthcare providers may update data in their record using the federal NPI registry website, and are required to do so within 30 days of a change in their information.

CarePrecise LLC reserves the right to make changes in the data and data structure as it deems necessary to preserve the quality of the product. Please read the Notice at the bottom of the page https://www.careprecise.com/help/ for additional information about the data.