Home Health Policies: Public Provider and Supplier Enrollment Files

Summary
To improve provider and supplier enrollment data sharing and transparency, CMS is making publically available a subset of Provider Enrollment, Chain, and Ownership System (PECOS) data. Through a series of files, this release will make key provider and supplier data available for use by the healthcare community for research and to increase awareness in the provider and supplier community about enrollment information on file with CMS. These files will provide a clear and transparent way for providers, suppliers, state Medicaid programs, private payers, and other interested individuals or organizations to leverage Medicare Provider Enrollment data.

The long-term goal of this initiative is to continue to expand data elements available in the files and eventually consolidate other existing public lists, such as the Ordering and Referring File, Part D Prescribing File, and Revalidation Lists.

Background
Since CMS released the claims payment information for 2012, CMS has received a growing number of data requests for provider enrollment data, and there is a growing interest from the health care industry to identify Medicare-enrolled providers and suppliers and their associations to groups/organizations.

CMS continues to move toward data transparency for all non-sensitive Medicare provider and supplier enrollment data. This aligns with the agency’s effort to promote and practice data transparency for Medicare information. Publishing this data allows users, including other health plans, to easily access and validate provider information against Medicare data.  

Scope
The Public Provider Enrollment files will include enrollment information for providers and suppliers who were approved to bill Medicare at the time the file was created. The data elements on the files are open to the public. This data will focus on data relationships as they relate to Medicare Provider Enrollment.

The Provider Enrollment data will be published on https://data.cms.gov/public-provider-enrollment and will be updated on a quarterly basis. The initial data will consist of individual and organization provider and supplier enrollment information similar to what is on Physician Compare; however, it will be directly from PECOS and will only be updated through updates to enrollment information. Elements will include:

• Enrollment ID and PECOS Unique IDs
• Provider or Supplier Enrollment Type and State
• Provider’s or Supplier’s First and Last Name/ Legal Business Name
• Gender
• NPI
• Provider or Supplier Specialty,
• Limited address information. (City, State, ZIP code)

Additional data elements will be added in future releases. We appreciate industry feedback on what enrollment data will provide value and align with other CMS projects, such as physician utilization data.