Doctors

A request for a specific [npi] will return all of the available information on a provider. An NPI, or National Provider Identifier, is the unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). See the API page for details on structuring a request.

JSON Object Parameters

Object Description Format Data Source
npi_last_update_date Date on which this NPI was last updated YYYY-MM-DD CMS NPPES NPI Registry
npi_deactivation_date Date on which this NPI was deactivated YYYY-MM-DD CMS NPPES NPI Registry
npi_reactivation_date Date on which this NPI was reactivated YYYY-MM-DD CMS NPPES NPI Registry
replacement_npi The replacement NPI, in the event that the provider has been issued one 10-digit number CMS NPPES NPI Registry
ein Nine-digit employer identification number assigned by the IRS Nine-digit number CMS NPPES NPI Registry
provider_organization_name_ legal_business_name The legal business name of the provider’s organization String CMS NPPES NPI Registry
provider_last_name_legal_name Provider’s legal last name String CMS NPPES NPI Registry
provider_first_name Provider’s first name String CMS NPPES NPI Registry
provider_middle_name Provider’s middle name String CMS NPPES NPI Registry
provider_name_prefix_text Provider’s name prefix String CMS NPPES NPI Registry
provider_name_suffix_text Provider’s name suffix String CMS NPPES NPI Registry
provider_credential_text Provider’s credential text (i.e., “MD”). String CMS NPPES NPI Registry
provider_first_line_ business_mailing_address First line of provider’s business mailing address String CMS NPPES NPI Registry
provider_second_line_ business_mailing_address Second line of provider’s business mailing address String CMS NPPES NPI Registry
provider_business_mailing_ address_city_name City name of provider’s business mailing address String CMS NPPES NPI Registry
provider_business_mailing_ address_state_name State name of provider’s business mailing address String CMS NPPES NPI Registry
provider_business_mailing_ address_postal_code Postal code of provider’s business mailing address Nine-digit number CMS NPPES NPI Registry
provider_business_mailing_ address_country_code Country code of provider’s business mailing address Two-character string CMS NPPES NPI Registry
provider_business_mailing_ address_telephone_number Telephone number of provider’s business address 10-digit number (no spaces/hyphens) CMS NPPES NPI Registry
provider_business_mailing_ address_fax_number Fax number of provider’s business address 10-digit number (no spaces/hyphens) CMS NPPES NPI Registry
provider_first_line_business_ practice_location_address First line of provider’s business practice location String CMS NPPES NPI Registry
provider_second_line_business_ practice_location_address Second line of provider’s business practice location String CMS NPPES NPI Registry
provider_business_practice_ location_address_city_name City name of provider’s business practice location String CMS NPPES NPI Registry
provider_business_practice_ location_address_state_name State name of provider’s business practice location String CMS NPPES NPI Registry
provider_business_practice_ location_address_postal_code Postal code of provider’s business practice location Nine-digit number CMS NPPES NPI Registry
provider_business_practice_ location_address_country_code Country code of provider’s business practice location Two character string CMS NPPES NPI Registry
provider_business_practice_ location_address_telephone_number Telephone number of provider’s business practice location 10-digit number (no spaces/hyphens) CMS NPPES NPI Registry
provider_business_practice_ location_address_fax_number Fax number of provider’s business practice location 10-digit number (no spaces/hyphens) CMS NPPES NPI Registry
provider_gender_code Provider gender One character string (M or F) CMS NPPES NPI Registry
provider_specialty The health care provider’s self-identified primary specialty. This is provided in the form of 10-digit code called the “Healthcare Provider Taxonomy Code.” You can read more about the Healthcare Provider Taxonomy Code, and view a full list of codes, on the CMS website. 10-digit number (no spaces/hyphens) CMS NPPES NPI Registry
provider_specialty_display A human-readable description of the provider's primary specialty (given as a code in physician_specialty.) You can read more about this taxonomy crosswalk and view the full crosswalk file on the CMS website. String CMS Healthcare Provider Taxonomy Code Crosswalk
hhs_exclusion A Boolean flag indicating that the provider was excluded in recent years from participation participation in Medicare, Medicaid and all other Federal health care programs. Individuals and entities that are excluded may be reinstated at a future date. Please check hhs_exclusion_reinstatement_date to see if this provider has been reinstated. Causes for exclusion include: convictions relating to health care fraud, convictions relating to controlled substances, or convictions relating to patient abuse or neglect. To read more about the process that HHS OIG uses to determine exclusions, you can read its FAQ Boolean U.S. Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities Database
hhs_exclusion_date The date on which the provider was excluded from participation in Medicare, Medicaid and all other Federal health care programs. YYYY-MM-DD U.S. Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities Database
hhs_exclusion_reinstatement_date The date on which the provider’s participation in Medicare, Medicaid and all other Federal health care programs was reinstated. If this field is null, this provider has not been reinstated YYYY-MM-DD U.S. Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities Database
hhs_exclusion_type The Social Security Act exclusion code String U.S. Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities Database
hhs_exclusion_type_description The description matching the Social Security Act exclusion code. String U.S. Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities Database
hhs_exclusion_updated The date on which the provider’s HHS exclusion status was updated YYYY-MM-DD U.S. Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities Database
medicare_participation A Boolean flag indicating whether the provider participates in Medicare Boolean Centers for Medicare Medicaid Services
medicare_participation_updated The date on which the provider’s Medicare participation status was updated YYYY-MM-DD Centers for Medicare Medicaid Services
revoked_from_medicare A Boolean flag indicating whether the provider’s billing privledges are currently revoked from Medicare. To read more about how CMS can revoke a provider’s enrollment in the Medicare program, read the statute. Boolean Centers for Medicare & Medicaid Services (FOIA request)
revoked_updated The date on which the provider’s Medicare revocation status was updated YYYY-MM-DD Centers for Medicare & Medicaid Services (FOIA request)
terminated_by_medicaid A boolean flag indicating whether the provider is currently terminated from at least one state’s Medicaid program. Boolean Centers for Medicare & Medicaid Services (FOIA request)
terminated_states A string of space-deliminated state abbreviations. This is a list of all states in which this provider is currently terminated from its Medicaid program. String Centers for Medicare & Medicaid Services (FOIA request)
terminated_reapply_eligible If a state abbreviation is returned, this provider is eligible to reapply for reinstatement in the Medicaid program in that state. If "NA" is returned, then this provider is not eligible to reapply for reinstatement. If we do not have any information about this provider's Medicaid status, this field will return null. Please note that while we know a provider's eligibility to re-enroll, the Centers for Medicare and Medicaid Services does not keep data on whether an individual provider has successfully re-enrolled into a state Medicaid program, so it's possible that this provider has indeed re-enrolled. String Centers for Medicare & Medicaid Services (FOIA request)
terminated_updated The date on which the provider’s Medicaid termination status was updated YYYY-MM-DD Centers for Medicare & Medicaid Services (FOIA request)
average_number_of_services Average number of services (both medical services and drugs) provided per patient. Services include items such as:
  • Office visits
  • Ambulance
  • Lab tests
  • In-hospital care
  • Drug infusions
    		•  Number, rounded to two decimal places ProPublica's Treatment Tracker
    peers_average_number_of_services Average number of services provided per patient by the doctor’s peers (those in the same specialty and state). Services include items such as:
  • Office visits
  • Ambulance
  • Lab tests
  • In-hospital care
    		•  Number, rounded to two decimal places ProPublica's Treatment Tracker
    average_paid_per_patient The average amount that Medicare paid this provider per patient Number, rounded to two decimal places ProPublica's Treatment Tracker
    peers_average_paid_per_patient The average amount that Medicare paid per patient to the provider’s peers (those in the same specialty and state) Number, rounded to two decimal places ProPublica's Treatment Tracker
    percentage_of_5_office_visits Percentage of established patient office visits (CPT codes 99211-99215) categorized as a level 5. A level 5 indicates the most intensive and costly visit Number (not rounded) ProPublica's Treatment Tracker
    relative_number_of_5s_to_peers Compares the percentage of this provider’s established patient office visits (CPT codes 99211-99215) categorized as a level 5 with that of the provider’s peers. A level 5 indicates the most intensive and costly visit. The categories are:
  • “This provider did not bill Medicare for any 5’s.”
  • “This provider charged Medicare for a lower percentage of 5’s than their peers”
  • “This provider charged Medicare for about the same percentage of 5’s as their peers”
  • “This provider charged Medicare for a higher percentage of 5’s than their peers.”
  • “More than 90 percent of this provider’s office visits were billed as 5s.”
    • Note: Just because a provider has a higher proportion of complex visits than peers is not necessarily an indication of overtreatment, but it may be worth asking about.    		 String (“higher” or “lower” or “same”) ProPublica's Treatment Tracker
    performs_more_services_than_peers Performs more services than 90% of peers Boolean ProPublica's Treatment Tracker
    paid_more_per_patient_than_peers Doctor is paid more per patient than 90% of peers. This could potentially indicate “upcoding,” or billing for higher-level services than are actually delivered, by some providers. You can read the ProPublica story on this topic, or refer to the Treatment Tracker methodology. It could also be an indication of the provider potentially delivering more services than are necessary. String ProPublica's Treatment Tracker
    treatment_scope Date range for which data is included; applies to all fields sourced from Treatment Tracker String ProPublica's Treatment Tracker
    number_of_payments Total number of payments made to this doctor from pharmaceutical or medical device companies. These payments are “general payments”: 15 categories including promotional speaking, consulting, meals, travel and royalties. It does not include research payments nor does it include physicians’ ownership stakes in companies. ProPublica’s analysis found that most doctors take payments, and that doctors who receive payments are, on average, more likely to prescribe a higher percentage of brand-name drugs. Number ProPublica's Treatment Tracker
    total_payment_amount Total payment amount made to this doctor from pharmaceutical or medical device companies. ProPublica’s analysis found that most doctors take payments, and that doctors who receive payments are, on average, more likely to prescribe a higher percentage of brand-name drugs. Number ProPublica's Dollars for Docs
    number_of_companies_paying Number of pharmaceutical or medical device companies paying this doctor Number ProPublica's Dollars for Docs
    number_of_days Number of days (out of 365) that a doctor received payment from a pharmaceutical or medical device company. XYZ: will refresh this month? Number ProPublica's Dollars for Docs
    speaking_payment Indicates whether or not the doctor was paid to give promotional talks for pharmaceutical or medical device companies.
    Note: The category that encompasses speaking payments has been used by companies for other types of payments for which other categories are not available. We label this category “speaking/other.” For more information and context on doctors acting as paid speakers and why this matters, you can view this ProPublica article on doctors and speaking fees.    		 Boolean ProPublica's Dollars for Docs
    top_5_drugs_for_doctors The top five drugs for which a doctor has received payment String ProPublica's Dollars for Docs
    top_5_devices_for_doctor Top five devices for which a doctor has received payment String ProPublica's Dollars for Docs
    payments_updated Date that the Dollars for Docs payment information was last updated for this provider YYYY-MM-DD ProPublica's Dollars for Docs
    payments_scope Date range for which data is included; applies to all data sourced from Dollars for Docs ProPublica's Dollars for Docs
    number_of_patients_receiving_ prescriptions Number of patients in Medicare Part D who received at least one prescription from this doctor.
    Note: The data may not tell us everything. ProPublica interviewed many high-volume prescribers to better understand their patients and their practices. Some told us their numbers were high because they were credited with prescriptions by others working in the same practice. In addition, providers who primarily work in long-term care facilities or busy clinics with many patients naturally may write more prescriptions.    		 Number ProPublica's Prescriber Checkup
    number_of_prescriptions Number of prescriptions issued by this doctor in Medicare Part D, including refills.
    Note: The data may not tell us everything. ProPublica interviewed many high-volume prescribers to better understand their patients and their practices. Some told us their numbers were high because they were credited with prescriptions by others working in the same practice. In addition, providers who primarily work in long-term care facilities or busy clinics with many patients naturally may write more prescriptions.     		Number ProPublica's Prescriber Checkup
    percentage_of_patients_receiving_narcotics Percentage of this doctor’s Medicare Part D patients receiving narcotic painkillers Number ProPublica's Prescriber Checkup
    percentage_of_patients_of_peers_ receiving_narcotics Percentage of patients of this doctor’s peers receiving narcotics Number ProPublica's Prescriber Checkup
    percentage_of_drugs_dangerous_for_seniors Percentage of this doctor’s Part D drugs to those over age 65 that may be potentially dangerous for seniors. You can read more about issues with doctors prescribing drugs that are dangerous for seniors in this ProPublica article. Number ProPublica's Prescriber Checkup
    percentage_of_drugs_from_ peers_dangerous_for_seniors Percentage of this doctors’ peers’ drugs to seniors that are dangerous for seniors Number ProPublica's Prescriber Checkup
    brand_name_prescriber Indicates whether the doctor prescribes far more or far less of brand name prescription drugs, relative to their peers. The categories indicate two standard deviations from the mean.
  • Comparisons do not take into account the medical conditions of patients. Medications for certain conditions do not have generic alternatives, so patients would receive more expensive brand name drugs.
    • No comparisons are shown if 10 or fewer prescribers in the state share this specialty.     		String (“Far more than peers” or “Far less than peers”) ProPublica's Prescriber Checkup
    drug_price Indicates whether the average cost of drugs prescribed by this doctor is far more or far less costly than the average cost of drugs prescribed by their peers. The categories indicate two standard deviations from the mean.
  • Note: The type of patients some doctors see may affect their rate of prescribing name-brand (and therefore more expensive) drugs. Some of the physicians who prescribe name brands at far higher rates than their peers specialize in treating HIV/AIDS, for instance. The drugs for these patients are expensive and there aren’t comparable generics.
    		•  String (“Far more than peers” or “Far less than peers”) ProPublica's Prescriber Checkup
    prescriptions_scope Date range for which data is included; applies to all data sourced from Prescriber Checkup ProPublica's Prescriber Checkup
    hospitals Hospitals at which this doctor has performed one of our specified surgeries Array of strings ProPublica's Surgeon Scorecard
    surgeries Indicates which surgeries this doctor performs. This field contains an array of objects, with each object containing a number of fields that describe the surgery and complication rate. Array of objects ProPublica's Surgeon Scorecard
    code Four-digit code indicating which surgery is being described Four-digit code ProPublica's Surgeon Scorecard
    description Name of the surgery being described String ProPublica's Surgeon Scorecard
    count How many times the provider performed this type of surgery. Due to Medicare’s privacy restrictions, sometimes this field displays a range of “1-10” instead of an exact value. Number ProPublica's Surgeon Scorecard
    complications_count The number of patients who underwent this procedure with the doctor and suffered a complication Number ProPublica's Surgeon Scorecard
    adjusted_complication_rate The ACR (Adjusted Complication Rate) is a figure calculated by ProPublica that describes the rate of complications for a given doctor, adjusting for several variables, including performance of the hospital and the health and age of a surgeon’s patients.
    A high adjusted complication rate indicates that a surgeon’s patients suffered complications more often than his or her peers. A low rate indicates that a surgeon’s patients fared better overall.
    ACR calculation methodology: The data used to calculate the ACR comes from Medicare billing records for in-patient hospital stays. To calculate a surgeon’s ACR for a given procedure, we first divided the number of the surgeon’s patients who suffered a complication by the total number of surgeries he or she performed. Then we factored in a variety of other elements, such as differences in patient health, age and hospital quality. The result is an ACR with a confidence interval with an upper and lower bound: the more data we have, the higher our confidence and the narrower the confidence interval.
    Note: Do not compare ACRs across procedures. Each of the surgical procedures in our data has a different underlying risk of complication. A high raw complication rate or ACR for one procedure might be within the range of normal for a different procedure. Simply because a surgeon has a higher ACR than another doesn’t mean s/he is a worse performer – unless both surgeons are performing the same procedure. It is inappropriate to compare the ACR for one surgery to the ACR for a different surgery.
    Further reading: You can read an in-depth methodology that goes into more detail about how the ACR was calculated, or a shorter version.    		 String ProPublica's Surgeon Scorecard
    high_adjusted_complication_rate The upper bound of this surgeon’s ACR band for this surgery Number, rounded to one decimal place ProPublica's Surgeon Scorecard
    low_adjusted_complication_rate The lower bound of this surgeon’s ACR band for this surgery Number, rounded to one decimal place ProPublica's Surgeon Scorecard
    adjusted_complication_rate_high_flag Indicates whether or not this surgeon’s entire ACR band falls into the “high” ACR band for this type of surgery. Boolean ProPublica's Surgeon Scorecard
    no_complications Indicates that the doctor has no complications for this surgery. Note that even doctors who have no complications may have an above-zero ACR, due to the way the ACR is calculated Boolean ProPublica's Surgeon Scorecard
    surgeries_updated Date on which the Surgeon Scorecard information was last updated for this provider YYYY-MM-DD ProPublica's Surgeon Scorecard
    surgeries_scope Date range for which data is included; applies to all fields sourced from Surgeon Scorecard String ProPublica's Surgeon Scorecard