The Medicare Physician & Other Practitioners by Provider and Service dataset provides information on use, payments, and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service.

 

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The CMS Program Statistics - Medicare Providers summary tables provide data on institutional (i.e., hospitals, skilled nursing facilities, home health agencies, hospices, etc.) and non-institutional (i.e., physicians, nonphysicians, specialists, and suppliers) providers. 

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data.

 

Below is the list of tables:

MDCR PROVIDERS 1.  Medicare Providers: Number of Medicare Certified Institutional Providers, Yearly Trend
MDCR PROVIDERS 2.  Medicare Providers:  Number of Medicare Certified Inpatient Hospital and Skilled Nursing Facility Beds and Beds Per 1,000 Enrollees, Yearly Trend
MDCR PROVIDERS 3.  Medicare Providers:  Number of Medicare Certified Facilities, by Type of Control, Yearly Trend
MDCR PROVIDERS 4.  Medicare Providers:  Number of Skilled Nursing Facilities and Medicare Certified Hospitals, and Number of Beds, by State, Territories, Possessions and Other Areas
MDCR PROVIDERS 5.  Medicare Providers:  Number of Medicare Certified Providers, by Type of Provider, by State, Territories, Possessions, and Other Areas
MDCR PROVIDERS 6.  Medicare Providers:  Number of Medicare Non-Institutional Providers by Specialty, Yearly Trend
MDCR PROVIDERS 7.  Medicare Providers:  Number of Medicare Non-Institutional Providers, by State, Territories, Possessions, and Other Areas, Yearly Trend

The Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) dataset provides information on a random sample of FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules. The dataset contains information on type of FFS claim, Diagnosis Related Group (DRG) and Healthcare Common Procedure Coding System (HCPCS) codes, provider type, type of bill, review decision, and error code.

 

Please note, each reporting year (RY) contains claims submitted July 1 two years before the report through June 30 one year before the report. For example, the 2023 data contains claims submitted July 1, 2021 through June 30, 2022.

The Pending Initial Logging and Tracking (L & T) Physicians dataset provides a list of pending applications that have not been processed by CMS contractors.

The CMS Program Statistics - Medicare Part A & Part B - All Types of Service tables provide use and payment data by type of coverage and type of service. 

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data.

 

Below is the list of tables:

MDCR SUMMARY AB 1.  Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for All Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend
MDCR SUMMARY AB 2.  Medicare Part A and Part B Summary:  Utilization, Program Payments, and Cost Sharing for Aged Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend
MDCR SUMMARY AB 3.  Medicare Part A and Part B Summary:  Utilization, Program Payments, and Cost Sharing for Disabled Original Medicare Beneficiaries by Type of Coverage and Type of Service, Yearly Trend
MDCR SUMMARY AB 4.  Medicare Part A and Part B Summary:  Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage, Demographic Characteristics, and Medicare-Medicaid Enrollment Status
MDCR SUMMARY AB 5.  Medicare Part A and Part B Summary:  Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage and by Area of Residence
MDCR SUMMARY AB 6.  Medicare Part A and Part B Summary:  Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Entitlement, Amount of Program Payments, Type of Coverage, and Type of Service

ATTENTION USERS

Some Providers' Opt-Out Status may end early due to COVID 19 waivers. Please contact your respective MAC for further information.

 

For more information on the opt-out process, see Manage Your Enrollment or view the FAQ section below.

 

The Opt Out Affidavits dataset provides information on providers who have decided not to participate in Medicare. It contains provider's NPI, specialty, address, and effective dates.

The Medicare Demonstrations dataset provides information on demonstrations conducted in the CMS Innovation Center. It includes the demonstration project name, type, description, year, and website for the demonstration page.

The Hospital Provider Cost Report dataset provides select measures from the hospital annual cost report. This data includes provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data organized by CMS Certification Number.

The Skilled Nursing Facility (SNF) All Owners dataset provides information on all owners of SNFs currently enrolled in Medicare. This data includes ownership information such as ownership name, ownership type, ownership address and ownership effective date.

The Medicare Part B by Drug dataset presents information on spending for drugs administered in doctors’ offices and other outpatient settings by physicians and other healthcare providers to Medicare Part B enrollees. 

The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes consumer-friendly descriptions of the drug uses, clinical indications, and manufacturer(s).

Drug spending metrics for Part B drugs represent the full value of the product, including the Medicare payment and beneficiary liability. All Part B drug spending metrics are calculated at the HCPCS level.