CMS (NPPES)

Overview

Centers for Medicare and Medicaid Services (CMS) is a US federal agency that provides healthcare to Americans through Medicare, Medicaid, and the Children’s Health Insurance Program. CMS developed the National Plan & Provider Enumeration System (NPPES) to issue mandatory National Provider Identifier (NPI) codes to all healthcare providers in the United States. Cybersyn CMS data includes the below details of all healthcare providers actively registered with the NPPES and those that deactivated on or after August 1, 2023.

Example topics covered:

• Names
• Emails
• Business and practice locations
• Mailing addresses
• License numbers
• Specialties
• NPI issuance, deactivation and reactivation dates
• Point-in-time data for deactivated NPIs
• NPI to NUCC taxonomy mapping

Key Attributes

Geographic Coverage	United States
Entity Level	NPI
Release Frequency	Weekly - Monday between 4am-7am ET
History	NPI creation dates on or after May 23, 2005 Note, metadata is provided for all actively registered providers and those with a NPI deactivation date on or after August 1, 2023

Notes

NPI Index: The nppes_npi_index contains information on when NPIs were first issued, deactivated, or reactivated - dating back to 2005. This table also includes a boolean flag to indicate if an NPI is currently active. NPI codes are unique 10-digit numbers used to identify healthcare providers. Providers include both individual practitioner (e.g. an individual doctor, nurse) and organization (hospital clinic, doctors office). The administrative simplification provisions of HIPAA require all covered healthcare providers, plans and clearinghouses use NPIs in administrative and financial transactions (e.g. claim payments, referrals, diagnosis coding). If a provider is no longer practicing, they are responsible for manually deactivating their NPI with the NPPES.

This dataset is particularly useful for teams who requires a comprehensive directory of every NPI in the United States and are looking to outsource the maintenance/support of the feed in a data pipeline on Snowflake.

NPPES to NUCC Mapping: Cybersyn maps healthcare provider data from the NPPEs to the National Uniform Claim Committee (NUCC) Health Care Provider Taxonomy that includes Provider Grouping, Classification, and Area of Specialization

Deactivated NPIs and Point-in-Time Data: While all NPIs appear in the nppes_npi_index table, only actively registered NPIs as well as NPIs deactivated after August 1, 2023 appear in the nppes_practitioner_attributes and nppes_organization_attributes tables. Cybersyn tracks point-in-time data for deactivated NPIs. CMS deletes this data (other than marking the NPI inactive) whereas we keep all the requisite fields from these historical records.

Sole Proprietor Classification: Sole proprietors are included in both the nppes_organization_attributes and the nppes_practitioner_attributes tables because they are counted as both an individual practitioner as well as an organization. Sole proprietors are flagged in the organization table with a boolean indicator in the is_sole_proprietor column.

Provider, Practitioner, Organization Definitions:

• Practitioner - an individual who has a NPI (e.g. doctors, physicians, nurse practitioners)
• Organization - business with an NPI (e.g. hospital, clinic, doctor's office). Note that when a practitioner is a sole proprietor (e.g. she has her own doctor's office) then the person is considered both a practitioner and an organization.
• Provider - broad term for any practitioner or organization that has an NPI

Cybersyn Products

Tables above are available in the following Cybersyn data product:

• Cybersyn Foundations - PAID

Sample Queries

Practitioners by speciality or location

List the names and addresses of all dentists in NYC.

SELECT DISTINCT
	practitioner.last_name,
	practitioner.first_name,
	address.address_first_line,
	address.city,
	address.zip_code
FROM cybersyn.nppes_practitioner_attributes AS practitioner
INNER JOIN cybersyn.nppes_nucc_taxonomy AS taxonomy
	ON (taxonomy.npi = practitioner.npi)
INNER JOIN cybersyn.nppes_provider_addresses AS address
	ON (address.npi = taxonomy.npi)
INNER JOIN cybersyn.geography_index AS geo
	ON (geo.geo_id = address.geo_id_city)
WHERE
	taxonomy.level_1_grouping = 'Dental Providers'
	AND taxonomy.is_primary_taxonomy = TRUE
	AND address.address_type = 'Primary Practice'
	AND geo.geo_name ILIKE 'NEW YORK'
ORDER BY address.zip_code;

Names and primary practice location of medical students

Find the names and primary practice location of all medical students in the United States.

SELECT
	practitioner.npi,
	practitioner.last_name,
	practitioner.first_name,
	address.address_first_line,
	address.city,
	address.state,
	address.zip_code
FROM cybersyn.nppes_practitioner_attributes AS practitioner
INNER JOIN cybersyn.nppes_nucc_taxonomy AS taxonomy
	ON (taxonomy.npi = practitioner.npi)
INNER JOIN cybersyn.nppes_provider_addresses AS address
	ON (address.npi = taxonomy.npi)
WHERE
	address.address_type = 'Primary Practice'
	AND taxonomy.is_primary_taxonomy = TRUE
	AND taxonomy.level_1_grouping = 'Student, Health Care';

Hospitals with a particular specialty

Find all names, NPI, and taxonomy codes for healthcare organizations that specialize in oncology.

SELECT
	org.organization_name,
	org.npi,
	tax.nucc_taxonomy_code,
	tax.level_2_classification AS classification,
	tax.level_3_specialization AS specialization
FROM cybersyn.nppes_nucc_taxonomy AS tax
INNER JOIN cybersyn.nppes_organization_attributes AS org
	ON (org.npi = tax.npi)
WHERE
	org.is_sole_proprietor = FALSE
	AND tax.is_primary_taxonomy = TRUE
	AND tax.level_3_specialization ILIKE '%oncology%';

Disclaimers

The data in this product is sourced from Centers for Medicare and Medicaid Services (CMS). Cybersyn is not endorsed by or affiliated with any of these providers. Contact support@cybersyn.com for questions.