Medicare Physician and Other Practitioners Data

Key facts

Published by

CMS, on data.cms.gov, one calendar year per release

Built from

Final action Medicare fee-for-service Part B professional claims

Granularity

Rendering provider NPI by HCPCS code and place of service

First data year

2012

Suppression

Rows derived from fewer than 11 beneficiaries are excluded

What is Medicare Physician and Other Practitioners data?

CMS publishes this dataset each year from Medicare Part B claims submitted by physicians, nurse practitioners, physician assistants, therapists and other practitioners, as well as some organizations that bill Part B professional services. It was previously released as the Medicare Provider Utilization and Payment Data: Physician and Other Supplier public use file.

The data covers Medicare fee-for-service Part B only. It does not include Medicare Advantage, even though by 2024 more than half of eligible Medicare beneficiaries were enrolled in Medicare Advantage plans. It also excludes commercial and Medicaid patients, hospital facility claims and durable medical equipment supplier claims, which CMS reports in separate files.

How the dataset is structured

Rows are keyed on the National Provider Identifier (NPI) and Healthcare Common Procedure Coding System (HCPCS) codes, in three views:

• By Provider and Service: one row per rendering NPI, HCPCS code and place of service (facility or non-facility), with services, distinct beneficiaries, average submitted charge, average Medicare allowed amount, average Medicare payment and a standardized payment amount.
• By Provider: one row per NPI with totals across services, plus beneficiary demographics and chronic condition prevalence.
• By Geography and Service: totals for each HCPCS code nationally and by state.

Why Physician and Other Practitioners data matters

It is the main free source that links a named practitioner to the specific services they perform. Medical device and pharmaceutical teams use it to find high-volume proceduralists, estimate procedure markets by specialty and region, and profile physicians before outreach. Health systems use it to benchmark physicians and identify recruitment targets.

Payment fields support pricing and policy analysis. The allowed amount is the total Medicare-approved payment including beneficiary cost sharing, while the Medicare payment is the portion Medicare actually paid. The standardized amount removes geographic payment adjustments so providers in different regions can be compared.

Limitations of the Physician and Other Practitioners data

Because rows based on fewer than 11 beneficiaries are dropped, low-volume services and smaller practices are underrepresented. Services are reported under the rendering NPI, so volume for a group practice must be rebuilt by combining its individual practitioners.

The files show Medicare fee-for-service activity only, so they understate total volume in regions with high Medicare Advantage enrollment and for services common among younger patients. Releases lag the service year by roughly one to two years.