CarePrecise Select & State Healthcare Provider Database Fields

CarePrecise Select & State Database Data Tables & Fields  
Table Field Name Description of field, and/or source fieldname Additional information
tAddresses NPI National Provider Identifier (unique National Provider Identifier assigned to healthcare providers by the US Department of Health and Human Services)

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).

 

(Provider addresses; MDB and CSV formats) Mail1stAddr Provider First Line Business Mailing Address  
Mail2ndAddr Provider Second Line Business Mailing Address  
MailCity Provider Business Mailing Address City Name
 
MailState Provider Business Mailing Address State Code  
MailZip Provider Business Mailing Address Postal Code (most are 9-digit Zip Codes)  
MailCountry Provider Business Mailing Address Country Code (If outside U.S.)  
Prac1stAddr Provider First Line Business Practice Location Address  
Prac2ndAddr Provider Second Line Business Practice Location Address  
PracCity Provider Business Practice Location Address City Name  
PracState Provider Business Practice Location Address State Code    
PracZip Provider Business Practice Location Address Postal Code (most are 9-digit Zip Codes)  
PracCountry Provider Business Practice Location Address Country Code (If outside U.S.)

 

 
tEntity NPI National Provider Identifier Relational Key
(Provider entity and record information; MDB and CSV formats) EntityType Entity Type Code

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

 

ReplacementNPI Replacement NPI  
EIN Employer Identification Number (EIN) CMS is not yet providing tax numbers of this type
EnumDate Provider Enumeration Date  
UpdateDate Last Update Date Date this provider NPI record was last updated
DeactReason NPI Deactivation Reason Code Not currently populated
DeactDate NPI Deactivation Date Not populated because records in the current dataset are not deactivated. This field IS populated in the separate delta table tEntity_DEACT, described below.
ReactDate NPI Reactivation Date Not currently populated
Gender Provider Gender Code M or F for Type 1 providers
IsSoleProp Is Sole Proprietor Y = provider operates as a sole proprietor. No = not a sole proprietorship. X = question not answered by provider.
IsOrgSubpart Is Organization Subpart

For Type 2 providers, may be one of several organizational units, each with its own NPI number. Y = provider is a subpart. No = not a subpart. X = question not answered.

ParentOrgTIN Parent Organization TIN

CMS is not yet providing tax numbers of this type

 

InPECOS From monthly CMS PECOS distributions of PECOS-enrolled providers. Source: PECOS file distribution, linkage derived algorithmically* beginning with December 2011 release.

Y = 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)

 

Warning

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)

 

ExclType

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.

 

UPIN UPIN is a deprecated identifier no longer used  
Group From NPPES group taxonomy data.

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

 

tHumanNames NPI National Provider Identifier Relational Key
(Provider human names, esp. Type 1 individual providers; MDB and CSV formats) LN Provider Last Name (Legal Name) The enumerated provider's name
FN Provider First Name
MN Provider Middle Name
PN Provider Name Prefix Text
SN Provider Name Suffix Text
Cred Provider Credential Text
OthLN Provider Other Last Name "AKA" name: Nee name, nickname, etc.
OthFN Provider Other First Name
OthMN Provider Other Middle Name
OthPN Provider Other Name Prefix Text
OthSN Provider Other Name Suffix Text
OthCred Provider Other Credential Text
OthLNType Provider Other Last Name Type Code
AuthLN Authorized Official Last Name

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

AuthFN Authorized Official First Name
AuthMN Authorized Official Middle Name
AuthTitle Authorized Official Title or Position
AuthPN Authorized Official Name Prefix Text
AuthSN Authorized Official Name Suffix Text
AuthCred Authorized Official Credential Text

 

tOID NPI National Provider Identifier Relational Key
(Other identifiers, such as UPIN, OSCAR, PIN, Medicaid, etc., excluding NPI and taxonomy codes; MDB and CSV formats) OtherID Other Provider Identifier  
OtherIDType Other Provider Identifier Type Code
Description OtherIDType
Other
1
Medicaid
5
OtherIDState Other Provider Identifier State In the case of a state license code, this is the licensing state
OtherIDIssuer Other Provider Identifier Issuer  
OIDnum Source: Added by CarePrecise to indicate the original NPPES flat file Other Identifiers field number. The number of the NPPES Other Identifier field (1 through 50)

 

tOrgNames NPI National Provider Identifier Relational Key

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

 

OrgName_LBN Provider Organization Name (Legal Business Name) LBN
OthOrgName Provider Other Organization Name Other
OthOrgNameType Provider Other Organization Name Type Code
Description Type
Unexplained (both)
0
Former Name (indiv)
1
Professional Name (indiv)
2
Doing Business As (org)
3
Former LBN (org)
4
Other Name (both)
5
ParentOrgLBN Parent Organization LBN

 

 
tPhoneFax NPI National Provider Identifier Relational Key

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

 

MailPhone Provider Business Mailing Address Telephone Number  
MailFax Provider Business Mailing Address Fax Number  
PracPhone Provider Business Practice Location Address Telephone Number  
PracFax Provider Business Practice Location Address Fax Number  
AuthPhone Authorized Official Telephone Number

 

 
tTaxo NPI National Provider Identifier Relational Key

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

 

Taxo Healthcare Provider Taxonomy Code  
Lic Provider License Number  
LicState Provider License Number State Code  
TaxoSwitch Healthcare Provider Primary Taxonomy Switch  
Tnum  

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

 

TaxoDescr   Taxonomy code description (the specialty/subspecialty in English)

 

tTaxoGroups NPI National Provider Identifier Relational Key
(Provider Taxonomy codes indicating group practices; MDB and CSV formats) Gnum

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 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.

 

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.

 

  TaxoGroup Healthcare Provider Taxonomy Group_[1 through 15]

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

 

tCoLoCode NPI National Provider Identifier Relational Key
(MDB and CSV formats) CoLoCode

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 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.

 

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.

 

Count

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.

 

 
tAdded NPI National Provider Identifier Relational Key

(MDB and CSV formats)

DateDiscovered   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.

 

tDropped NPI National Provider Identifier Relational Key

(MDB and CSV formats)

DateDiscovered  

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.

 

EntityType Entity Type Code

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

 

ProvName  

This is a generated field based on EntityType.

 

Prac1stAddr Provider First Line Business Practice Location Address  
Prac2ndAddr Provider Second Line Business Practice Location Address  
PracCity Provider Business Practice Location Address City Name  
PracState Provider Business Practice Location Address State Name

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.

 

PracZip Provider Business Practice Location Address Postal Code  
PracCountry Provider Business Practice Location Address Country Code (If outside U.S.)  
PracPhone Provider Business Practice Location Address Telephone Number  
EnumDate Provider Enumeration Date  
UpdateDate Last Update Date Date this provider NPI record was last updated

 

tExcluded

LN Last name (Type 1 providers)

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.

 

(MDB and CSV formats) FN First name (Type 1 providers)
MN Middle Name (Type 1 providers)
OrgName Organization name (Type 2 providers)
Addr Street address
City City
State State
Zip Zip Code
DOB Date of Birth (currently unpopulated)
General Provider category
Specialty Provider specialty
UPIN Federal physician identifier code (legacy)
ExclType Exclusion type (why provider was excluded)
ExclDesc Exclusion Description
ExclDate Date provider was excluded (YYYYMMDD)

 

* 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 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. In like manner, the available federal data does not provide information on an individual provider's practice group(s); using record-linkage technology, we extract the group information by matching providers sharing the same practice location, and these group data can be corroborated or enriched with the group practice codes provided by CMS.