CMS Makes Available NPI Registry File
- By admin aapc
- In CMS
- February 1, 2010
- Comments Off on CMS Makes Available NPI Registry File
The Centers for Medicare & Medicaid Services (CMS) has made available a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in the Provider Enrollment, Chain and Ownership System (PECOS) that contain an NPI).
The Medicare Ordering and Referring file, which contains approximately 800,000 records, can be viewed online or downloaded from the Medicare Provider-Supplier Enrollment > OrderingReferring Report page of the CMS website. A new file will be made available periodically that will replace the posted file. At any given time, only one file (the most recent) will be available.
Users can search the PDF file for a particular physician or non-physician practitioner by NPI or by name. Please note the following: (1) Records are in alphabetical order based on the surname of the physician or non-physician practitioner; (2) Name suffixes (e.g., Jr.), if they exist, are not displayed; (3) There are no “duplicates” in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness; and (4) Deceased physicians and non-physician practitioners are not included in the file; (5) If a user is unsure of a physician or non-physician practitioner’s NPI, he or she can look it up in the NPI Registry. (Note that the record in the NPI Registry is not the Medicare PECOS enrollment record.)
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The CMS NPI registry has been available for over a year. When it was first available it kept the file in real time. The file is now delayed by 1 day for updates. However be aware if you use the file for mailing/location addresses. Some providers have not updated their information and as such their billing and location addresses may not be current.
I was receiving many notices from our DME companies “WARNING” physicians that if they didn’t file through PECOS they wouldn’t be able to refer patients! This list that CMS has provided re-assures me that my docs are all in the PECOS database – I am so glad they have made it available!
I think what’s important to note here is that the file CMS is making available is NOT the NPI registry but rather the Medicare Ordering and Referring file. As stated in the news release above, the NPI Registry is not the Medicare PECOS enrollment record.
To make a long story short; originally, CMS was to begin withholding payment from ordering and/or referring providers (starting with DME) who were not shown in the PECOS system on Jan 1, 2010 but it has been delayed until early April 2010. If a provider applied to participate with Medicare prior to 2003, according to CMS, it is likely that they would NOT be listed in PECOS and are required to re-validate through PECOS. The ordering/referring file was not previously available to us and, without it, would have required monster projects to obtain the information required to avoid having payment withheld by CMS.
For fast and free PECOS database search, check this article:
http://www.miravistallc.com/blog/?p=852
or go directly:
http://www.pfspays.com
Check out http://www.npiapi.com. We offer an easy to use API into the NPI Registry so you can integrate your own applications with the NPI data. We provide search query into the database and return results in XML or JSON format.
Thanks!
My children were requiring FL DH 527 last month and discovered a document management site that has a lot of sample forms . If others need to fill out FL DH 527 too , here’s http://goo.gl/l1qvqr
We are about to release the NPPES/NPI database in both Sql-Server and MySql. Free samples are available. Check out: http://npidatasource.com