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The MD-PPAS file assigns Medicare providers to medical practices based on tax identification numbers and elaborates on the Centers for Medicare & Medicaid Services (CMS) provider specialty classification. This provider-level dataset is built around two identifiers: the national provider identifier (NPI) and the tax identification number (TIN).

What does this file include? (variable highlights)

  • The MD-PPAS has been updated to version 2.3 from version 2.2 to reflect the following changes: 
    • The data now include variables on the percentage of a provider’s line items that are performed in eight place-of-service categories.
    • The data use a corrected form of the zip-code-to-CBSA crosswalk to assign providers to CBSA based on the zip code reported on their submitted claims. This correction resulted in a small percentage of providers that exist in both version 2.2 and version 2.3 with different values for their CBSA code and type variable.

Special considerations

  • In 2017, PECOS introduced a new hospitalist specialty designation. To accommodate this change, version 2.3 changes the definition of hospitalists to include any provider who self-identifies as such in the PECOS data as well as primary care physicians who had at least 90% of their line items in an inpatient hospital setting. 
  • The data source for the part B non-institutional claims data changed the method by which it identifies final action claims.  This modification can change the content of the claims data, e.g. procedure codes and allowed-charges dollar amounts. Consequently, there are some providers who no longer satisfy the criteria for inclusion in the MD-PPAS, leading the provider counts in the latest version of MD-PPAS to decline slightly.
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