Provider Utilization by Year

Access information on services and procedures provided to Original Medicare (fee-for-service) Part B beneficiaries by physicians and other healthcare professionals; aggregated by provider, service and geography.

The Provider dataset allows the user access to data such as services and procedures performed; charges submitted and payment received; and beneficiary demographic and health characteristics for providers treating Original Medicare (fee-for-service) Part B beneficiaries, aggregated by year.

Usage

utilization(
  year = NULL,
  npi = NULL,
  first = NULL,
  last = NULL,
  cred = NULL,
  entity = NULL,
  specialty = NULL,
  par = NULL,
  hcpcs = NULL,
  patients = NULL,
  services = NULL,
  charges = NULL,
  allowed = NULL,
  payment = NULL,
  avg_age = NULL,
  avg_risk = NULL,
  dual = NULL,
  ndual = NULL,
  address = NULL,
  city = NULL,
  state = NULL,
  zip = NULL,
  count = FALSE
)

Arguments

year

<int> Year data was reported

npi

<int> 10-digit national provider identifier

first, last

<chr> Individual/Organizational provider's name

cred

<chr> Individual provider's credentials

entity

<chr> 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.

specialty

<chr> Provider specialty reported on the largest number of claims submitted

par

<lgl> 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

<int> Total number of unique HCPCS codes

patients

<int> Total Medicare beneficiaries receiving services from the provider

services

<int> Total provider services

charges

<int> The total charges that the provider submitted for all services

allowed

<dbl> The Medicare allowed amount for all provider services. 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.

payment

<dbl> Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.

avg_age

<dbl> Average age of beneficiaries. Beneficiary age is calculated at the end of the calendar year or at the time of death

avg_risk

<dbl> Average Hierarchical Condition Category (HCC) risk score of beneficiaries

dual

<int> Number of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefits.

ndual

<int> Number of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar year.

address, city, state, zip

The provider's street address, city, state and zip code, as reported in NPPES.

count

<lgl> Return the total row count

Value

A tibble containing the search results.

Links

• Medicare Physician & Other Practitioners: by Provider API

• Medicare Physician & Other Practitioners: by Provider and Service API

• Medicare Physician & Other Practitioners: by Geography and Service API

Examples

utilization(count = TRUE)
#> ◼ utilization | 13,528,933 rows | 2,712 pages
utilization(npi = 1003000423)
#> ✔ utilization returned 12 results
#> ✔ Retrieving 12 pages
#> # A tibble: 12 × 22
#>     year        npi first last  cred  entity address city  state zip   specialty
#>    <int>      <int> <chr> <chr> <chr> <chr>  <chr>   <chr> <chr> <chr> <chr>    
#>  1  2013 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  2  2014 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  3  2015 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  4  2016 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  5  2017 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  6  2018 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  7  2019 1003000423 JENN… VELO… M.D.  I      11100 … CLEV… OH    44106 Obstetri…
#>  8  2020 1003000423 Jenn… Velo… M.D.  I      11100 … Clev… OH    44106 Obstetri…
#>  9  2021 1003000423 Jenn… Velo… M.D.  I      11100 … Clev… OH    44106 Obstetri…
#> 10  2022 1003000423 Jenn… Velo… M.D.  I      11100 … Clev… OH    44106 Obstetri…
#> 11  2023 1003000423 Jenn… Velo… M.D.  I      11100 … Clev… OH    44106 Obstetri…
#> 12  2024 1003000423 Jenn… Velo… M.D.  I      8300 T… Ment… OH    44060 Obstetri…
#> # ℹ 11 more variables: par <int>, hcpcs <int>, patients <int>, services <int>,
#> #   charges <int>, allowed <dbl>, payment <dbl>, avg_age <int>, avg_risk <dbl>,
#> #   dual <int>, ndual <int>