Basic Relational Data

The NPI is a unique 10-digit numerical code assigned to every HIPAA-covered healthcare provider, including individuals and organizations, by the U.S. Department of Human Services, Centers for Medicare and Medicaid Services (CMS).

tEntity
(Provider entity and record information; MDB and CSV formats)

From the Office of Inspector General's excluded providers database (LEIE), indicatying a sanction prevents the provider from billing Medicare. A warning in this field should not be taken as definitive; the user should check the tExcluded table and consider other sources of provider fraud and exclusion information. Up until the May 2017 release, this field was algorithmically derived for some records.*

The exclusion type from the LEIE database, explaining the reason that a provider was barred from billing Medicare. Fields with a Y in the Warning field will display this code.

The date of the exclusion from the LEIE database, where reported.

tEntity-B

(Provider entity and record information; MDB and CSV formats)

Algorithmically derived* from EPGH tExtendedPhysician.GradYear and/or CPAC tEntity.EnumDate 2009 forward.

tEntity-C

(Market data; MDB and CSV formats)

The source data (NPPES) permits group codes to be reported in up to 15 fields in this section. CarePrecise creates a one-to-many table, listing each of a provider's reported taxonomy group codes in a separate record. The Gnum is the NPPES Group Taxonomy field number in which the code was reported, allowing the code be matched with the specific group specialty in the tTaxo table. For instance, a code in tTaxoGroup field Gnum 3 indicates a group practice of the specialty reported in Tnum 3 in the tTaxo table.

Provider CoLoCode™ (co-location code, a CarePrecise algorithmically derived* exclusive). The NPI and CoLoCode comprise the dual relational key for this table. The NPI identifies the provider record, and the CoLoCode identifies the physical location. The CoLoCode is an up to 40-character string that stands in for detailed location data, and is not intended to be sensical to the human viewer.

Relational Key (composite)

This code is an algorithmically derived conformation of the provider's practice location, permitting identification of providers who practice at the same location, for instance, physician groups, dental groups, radiology groups, etc. By using this table in conjunction with the tTaxoGroups table, it is possible to visualize the group entity (generally an organization) and its provider members. CoLoCodes are created for Practice addresses in the United States (US) and US Minor Islands (UM).

Count of providers matching this co-location (algorithmically derived* conformation of the provider's practice location; see tCoLoCodes above). Indicates the number of providers practicing at this location.

* Marked above by an asterisk, algorithmically derived data in the datasets includes data that is extracted/mined from the source databases, but which has a margin of error and should not be relied upon as conclusive. Record linking algorithms are used to enrich our data when direct correlation (via a unique identifier field) is not available, using available information in name, address, phone, taxonomy, and other fields. In particular, some of the older data on providers excluded from billing Medicare (from the HHS Office of Inspector General's excluded providers database) can only be linked to NPI records by this means. Please note that when matches are found, there may be instances where an individual or firm has the same or similar name and location information as an excluded provider but is actually a different party. Therefore, it is important that you verify a potential match with the debarring agency identified in the record information. See the disclaimer appearing at the bottom of the documentation page.

Not all fields in all records are populated with data. Healthcare providers may update data in their record using the federal NPI registry website, and are required to do so within 30 days of a change in their information.

CarePrecise LLC reserves the right to make changes in the data and data structure as it deems necessary to preserve the quality of the product. Please read the Notice at the bottom of the page https://www.careprecise.com/help/ for additional information about the data.