Medicare Public Provider Enrollment API

library(provider)

The Medicare Fee-For-Service Public Provider Enrollment dataset includes information on providers who are actively approved to bill Medicare. These files are populated from Provider Enrollment and Chain Ownership System (PECOS) and contain basic enrollment and provider information, reassignment of benefits information and practice location city, state and zip. These files are not intended to be used as real time reporting as the data changes from day to day and the files are updated only on a quarterly basis. This data does not include information on opt-out providers. Information is redacted where necessary to protect Medicare provider privacy.

Examples

provider_enrollment(npi = 1003026055)
#> # A tibble: 1 × 11
#>   npi      pac_id enroll_id enroll_type_code enroll_type state organization_name
#>   <chr>    <chr>  <chr>     <chr>            <chr>       <chr> <chr>            
#> 1 1003026… 44868… I2017040… 14-46            PRACTITION… FL    NA               
#> # ℹ 4 more variables: first_name <chr>, middle_name <chr>, last_name <chr>,
#> #   gender <chr>

provider_enrollment(first_name = "Matthew", 
                    last_name = "Smith",
                    state = "FL")
#> # A tibble: 10 × 11
#>    npi     pac_id enroll_id enroll_type_code enroll_type state organization_name
#>    <chr>   <chr>  <chr>     <chr>            <chr>       <chr> <chr>            
#>  1 123512… 30725… I2004111… 14-08            PRACTITION… FL    NA               
#>  2 195232… 19512… I2007021… 14-10            PRACTITION… FL    NA               
#>  3 158868… 25674… I2011100… 14-29            PRACTITION… FL    NA               
#>  4 165936… 51939… I2012112… 14-37            PRACTITION… FL    NA               
#>  5 114441… 98303… I2014100… 14-97            PRACTITION… FL    NA               
#>  6 137603… 96384… I2018102… 14-65            PRACTITION… FL    NA               
#>  7 114454… 44868… I2019081… 14-02            PRACTITION… FL    NA               
#>  8 189115… 08405… I2020050… 14-93            PRACTITION… FL    NA               
#>  9 100344… 22648… I2021030… 14-35            PRACTITION… FL    NA               
#> 10 120513… 25676… I2021051… 14-97            PRACTITION… FL    NA               
#> # ℹ 4 more variables: first_name <chr>, middle_name <chr>, last_name <chr>,
#> #   gender <chr>

Data Dictionary

Variable	Description
npi	National Provider Identifier An NPI is a 10-digit unique numeric identifier that all providers must obtain before enrolling in Medicare. It is assigned to health care providers upon application through the National Plan and Provider Enumeration System (NPPES).
pac_id	PECOS Associate Control ID Provider associate level variable (PAC ID) from PECOS database used to link across tables. A PAC ID is a 10-digit unique numeric identifier that is assigned to each individual or organization in PECOS. All entity-level information (e.g., tax identification numbers and organizational names) is linked through the PAC ID. A PAC ID may be associated with multiple Enrollment IDs if the individual or organization enrolled multiple times under different circumstances.
enroll_id	Enrollment ID Provider enrollment ID from PECOS database used to link across tables. An Enrollment ID is a 15-digit unique alphanumeric identifier that is assigned to each new provider enrollment application. All enrollment-level information (e.g., enrollment type, enrollment state, provider specialty and reassignment of benefits) is linked through the Enrollment ID.
specialty_cd	Provider Type Code Provider enrollment application and enrollment specialty type. This field shows the provider’s primary specialty code. For practitioners and DME suppliers, please see the Secondary Specialty file for a list of secondary specialties (when applicable). Only about 20% of practitioners and DME suppliers have at least one secondary specialty.
specialty_desc	Provider Type Description Provider enrollment application and enrollment specialty type description, see PROVIDER_TYPE_CD - Reference for description of values.
state	State Code Provider enrollment state, abbreviated location. Providers enroll at the state level, so one PAC ID may be associated with multiple ENRLMT_IDs and multiple STATE_CD values.
first_name	First Name Individual provider first name.
middle_name	Middle Name Individual provider middle name.
last_name	Last Name Individual provider last name.
gender	Gender Individual provider gender.

Related Links

• Medicare Fee-For-Service Public Provider Enrollment API
• Medicare Fee-For-Service Public Provider Enrollment - Data Dictionary
• Fee-For-Service Public Provider Enrollment Methodology