Physician by Service • provider

library(provider)

Information on services and procedures provided to Original Medicare (fee-for-service) Part B (Medical Insurance) beneficiaries by physicians and other healthcare professionals.

The spending and utilization data in the Physician and Other Practitioners by Provider and Service Dataset are aggregated to the following:

the NPI for the performing provider,
the Healthcare Common Procedure Coding System (HCPCS) code, and
the place of service (either facility or non-facility).

There can be multiple records for a given NPI based on the number of distinct HCPCS codes that were billed and where the services were provided. Data have been aggregated based on the place of service because separate fee schedules apply depending on whether the place of service submitted on the claim is facility or non-facility.

Examples

physician_by_service(npi = 1003000126, year = 2020)
#> Error in physician_by_service(npi = 1003000126, year = 2020): could not find function "physician_by_service"

Data Dictionary

Variable	Description
`npi`	National Provider Identifier National Provider Identifier for the rendering provider on the claim.
`last_name`	Last Name/Organization Name of the Provider When the provider is registered in NPPES as an Individual (entity type code `I`), this is the provider’s last name. When the provider is registered as an Organization (entity type code `O`), this is the organization name.
`first_name`	First Name of the Provider When the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s first name. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.
`middle_name`	Middle Initial of the Provider When the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s middle initial. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.
`credential`	Credentials of the Provider When the provider is registered in NPPES as an individual (entity type code=’I’), these are the provider’s credentials. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.
`gender`	Gender of the Provider When the provider is registered in NPPES as an individual (entity type code=’I’), this is the provider’s gender. When the provider is registered as an organization (entity type code = ‘O’), this will be blank.
`entype`	Entity Type of the Provider Type of entity reported in NPPES. An entity code of ‘I’ identifies providers registered as individuals and an entity type code of ‘O’ identifies providers registered as organizations.
`street`	Street Address of the Provider The first line of the provider’s street address, as reported in NPPES.
`rndrng_prvdr_st2`	Street Address 2 of the Provider The second line of the provider’s street address, as reported in NPPES.
`city`	City of the Provider The city where the provider is located, as reported in NPPES.
`state`	State Abbreviation of the Provider The state where the provider is located, as reported in NPPES. The fifty U.S. states and the District of Columbia are reported by the state postal abbreviation. The following values are used for all other areas:
`fips`	State FIPS Code of the Provider FIPS code for rendering provider's state.
`zipcode`	Zip Code of the Provider The provider’s zip code, as reported in NPPES.
`ruca`	RUCA Code of the Provider Rural-Urban Commuting Area Codes (RUCAs), are a Census tract-based classification scheme that utilizes the standard Bureau of Census Urbanized Area and Urban Cluster definitions in combination with work commuting information to characterize all of the nation's Census tracts regarding their rural and urban status and relationships. The Referring Provider ZIP code was cross walked to the United States Department of Agriculture (USDA) 2010 Rural-Urban Commuting Area Codes.
`rndrng_prvdr_ruca_desc`	RUCA Description Description of Rural-Urban Commuting Area (RUCA) Code
`country`	Country Code of the Provider The country where the provider is located, as reported in NPPES. The country code will be ‘US’ for any state or U.S. possession.
`specialty`	Provider Type of the Provider Derived from the provider specialty code reported on the claim. For providers that reported more than one specialty code on their claims, this is the specialty code associated with the largest number of services.
`par`	Medicare Participation Indicator Identifies whether the provider participates in Medicare and/or accepts assignment of Medicare allowed amounts. The value will be ‘Y’ for any provider that had at least one claim identifying the provider as participating in Medicare or accepting assignment of Medicare allowed amounts within HCPCS code and place of service. A non-participating provider may elect to accept Medicare allowed amounts for some services and not accept Medicare allowed amounts for other services.
`hcpcs_cd`	HCPCS Code HCPCS code used to identify the specific medical service furnished by the provider. HCPCS codes include two levels. Level I codes are the Current Procedural Terminology (CPT) codes that are maintained by the American Medical Association and Level II codes are created by CMS to identify products, supplies and services not covered by the CPT codes (such as ambulance services). CPT codes, descriptions and other data only are copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). Please review the complete CMS AMA CPT License agreement which is presented to users when accessing the data. For additional information on HCPCS codes, visit the HCPCS general information page.
`hcpcs_desc`	HCPCS Description Description of the HCPCS code for the specific medical service furnished by the provider. HCPCS descriptions associated with CPT codes are consumer friendly descriptions provided by the AMA. CPT Consumer Friendly Descriptors are lay synonyms for CPT descriptors that are intended to help healthcare consumers who are not medical professionals understand clinical procedures on bills and patient portals. CPT Consumer Friendly Descriptors should not be used for clinical coding or documentation. All other descriptions are CMS Level II descriptions provided in long form. Due to variable length restrictions, the CMS Level II descriptions have been truncated to 256 bytes. As a result, the same HCPCS description can be associated with more than one HCPCS code. For complete CMS Level II descriptions, please visit the HCPCS Release Code Sets page.
`hcpcs_drug`	HCPCS Drug Indicator Identifies whether the HCPCS code for the specific service furnished by the provider is a HCPCS listed on the Medicare Part B Drug Average Sales Price (ASP) File. Please visit the ASP drug pricing page for additional information.
`place_of_srvc`	Place of Service Identifies whether the place of service submitted on the claims is a facility (value of ‘F’) or non-facility (value of ‘O’). Non-facility is generally an office setting; however other entities are included in non-facility. The following values are entities included in facility and non-facility:
`tot_benes`	Number of Medicare Beneficiaries Number of distinct Medicare beneficiaries receiving the service for each Rndrng_NPI, HCPCS_Cd, and Place_Of_Srvc.
`tot_srvcs`	Number of Services Number of services provided; note that the metrics used to count the number provided can vary from service to service.
`tot_day`	Number of Distinct Medicare Beneficiary/Per Day Services Number of distinct Medicare beneficiary/per day services. Since a given beneficiary may receive multiple services of the same type (e.g., single vs. multiple cardiac stents) on a single day, this metric removes double-counting from the line service count to identify whether a unique service occurred.
`avg_charges`	Average Submitted Charge Amount Average of the charges that the provider submitted for the service.
`avg_allowed`	Average Medicare Allowed Amount Average of the Medicare allowed amount for the service; this figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.
`avg_payment`	Average Medicare Payment Amount Average amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item service. Note: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, incurred a 2% reduction in Medicare payment. This is in response to mandatory across-the-board reductions in Federal spending, also known as sequestration.
`avg_std_pymt`	Average Medicare Standardized Payment Amount Average amount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for the line item service and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care.