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Medicare Physician & Other Practitioners - by Provider and Service

Use, payments and submitted charges for Original Medicare services, by provider NPI, HCPCS procedure code and place of service.

Official page on data.cms.govDownload CSVData dictionary

Freshness

Last posted
Period covered
Jan 1, 2024 to Dec 31, 2024
Update frequency
Annually

Dates as CMS lists them in its catalog.

Before you use it

  • Covers Original Medicare only, so care paid by Medicare Advantage plans is not included.

Columns 28

ColumnWhat it meansType
National Provider IdentifierRndrng_NPINational Provider Identifier (NPI) for the rendering provider on the claim. The provider NPI is the numeric identifier registered in NPPES.string
Last Name/Organization Name of the ProviderRndrng_Prvdr_Last_Org_NameWhen 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.string
First Name of the ProviderRndrng_Prvdr_First_NameWhen 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.string
Middle Initial of the ProviderRndrng_Prvdr_MIWhen 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.string
Credentials of the ProviderRndrng_Prvdr_CrdntlsWhen 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.string
Entity Type of the ProviderRndrng_Prvdr_Ent_CdType 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.string
Street Address 1 of the ProviderRndrng_Prvdr_St1The first line of the provider’s street address, as reported in NPPES.string
Street Address 2 of the ProviderRndrng_Prvdr_St2The second line of the provider’s street address, as reported in NPPES.string
City of the ProviderRndrng_Prvdr_CityThe city where the provider is located, as reported in NPPES.string
State Abbreviation of the ProviderRndrng_Prvdr_State_AbrvtnThe 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:string
State FIPS Code of the ProviderRndrng_Prvdr_State_FIPSFIPS code for rendering provider's state.string
Zip Code of the ProviderRndrng_Prvdr_Zip5The provider’s zip code, as reported in NPPES.string
RUCA Code of the ProviderRndrng_Prvdr_RUCARural-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 theUnited States Department of Agriculture (USDA) 2010 Rural-Urban Commuting Area Codes.string
RUCA DescriptionRndrng_Prvdr_RUCA_DescDescription of Rural-Urban Commuting Area (RUCA) Codestring
Country Code of the ProviderRndrng_Prvdr_CntryThe country where the provider is located, as reported in NPPES. The country code will be ‘US’ for any state or U.S. possession. For foreign countries (i.e., state values of ‘ZZ’), the provider country values include the following:string
Provider Type of the ProviderRndrng_Prvdr_TypeDerived 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.string
Medicare Participation IndicatorRndrng_Prvdr_Mdcr_Prtcptg_IndIdentifies 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.string
HCPCS CodeHCPCS_CdHCPCS 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.string
HCPCS DescriptionHCPCS_DescDescription 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.string
HCPCS Drug IndicatorHCPCS_Drug_IndIdentifies 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.string
Place of ServicePlace_Of_SrvcIdentifies 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.string
Number of Medicare BeneficiariesTot_BenesNumber of distinct Medicare beneficiaries receiving the service for each Rndrng_NPI, HCPCS_Cd, and Place_Of_Srvc.number
Number of ServicesTot_SrvcsNumber of services provided; note that the metrics used to count the number provided can vary from service to service.number
Number of Distinct Medicare Beneficiary/Per Day ServicesTot_Bene_Day_SrvcsNumber 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.number
Average Submitted Charge AmountAvg_Sbmtd_ChrgAverage of the charges that the provider submitted for the service.number
Average Medicare Allowed AmountAvg_Mdcr_Alowd_AmtAverage 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.number
Average Medicare Payment AmountAvg_Mdcr_Pymt_AmtAverage 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 percent reduction in Medicare payment. This is in response to mandatory across-the-board reductions in Federal spending, also known as sequestration.number
Average Medicare Standardized Payment AmountAvg_Mdcr_Stdzd_AmtAverage 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. Please refer to the “Additional Information” section of this document for more details on the standardization of Medicare payments.number

At a glance

Catalog
data.cms.gov
Publisher
Office of Enterprise Data and Analytics (OEDA)
Rows
9,781,673
Columns
28
State column
Rndrng_Prvdr_State_Abrvtn
Topics
Doctors and clinicians, Spending and use of services
Contact
IPAG_Data_Products@cms.hhs.gov

API

Free, no key needed. This request returns the first 10 rows as JSON:

https://data.cms.gov/data-api/v1/dataset/92396110-2aed-4d63-a6a2-5d6207d46a29/data?size=10

To keep only one state, filter on the Rndrng_Prvdr_State_Abrvtn column.

Versions 12

The newest version is the one linked above. Older releases stay on the official site.

  • 2024-12-01posted May 21, 2026
  • 2023-12-31posted Oct 28, 2025
  • 2022-12-02posted Mar 26, 2025
  • 2021-12-02posted Mar 26, 2025
  • 2020-12-02posted Mar 26, 2025
  • 2019-12-02posted Mar 26, 2025
  • 2018-12-02posted Mar 26, 2025
  • 2017-12-02posted Mar 26, 2025
Show 4 older versions
  • 2016-12-02posted Mar 26, 2025
  • 2015-12-02posted Mar 26, 2025
  • 2014-12-02posted Mar 26, 2025
  • 2013-12-02posted Mar 26, 2025

CMS's description

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.

Methodology and other documents from CMS:

The summary at the top was written by hand from this description. Record id cms:92396110-2aed-4d63-a6a2-5d6207d46a29. This record as JSON.

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