Physician Claims Information

Physician Claims data information is found on the Referral Source profile.

Physician Information

General physician information.

 Updated: Quarterly

 Current: 2018 except for Medical School, Graduation Year, and Primary Specialty data, this is from 2017)

Column Description
Name The physicians name.
NPI The physician's National Provider Identifier (NPI).
Gender The physician's gender.
Credentials The physician's level of education and ability to provide care.
Graduation Year The physician's year of graduation.
Primary Affiliation The physician's primary company or hospital.
Primary Specialty The physicians primary medical specialty.
Medical School Where the physician attended and graduated medical school.
Accepts Medicare Whether or not the physician accepts Medicare.
Date Pulled The date Enquire received the data.
CBSA The Core Based Statistical Area (CBSA) code for the physician. CBSA's are geographic areas consisting of one more counties and at least 10,000 people.
Taxonomy Code The physician's Taxonomy Code. Taxonomy Codes categorize the type, classification, and/or specialization of a health care provider.
Medicare Payments The total amount paid by Medicare.
Medicare Charges The total amount charged to Medicare.
Medicare Claims The total number of claims submitted to Medicare
Medicare Allowed The maximum amount Medicare will pay for covered health care services.

Top 10 Companies

The top 10 companies the physician refers to.

 Updated: Quarterly

 Current: 2013-2015

Column Description
Company The company's name.
Firm Type The company's firm type.
Company The company's name.
Ownership The ownership type of the company.
County The county where the company resides.
Zipcode The zip code where the company resides.
Network The group/system of the company.
Beds The total number of beds at the company.
Referrals The total referrals the physician has given to the company.
Unique Bene Total number of distinct patients.
Percent of Total The percent of total for referrals.
Referrals to Hospital ***

Firm Type Breakdown

The hospital/company types the physician refers to.

Column Description

Other IDs

The physicians additional Medicaid, Medicare, and other identifiers.

 Updated: Quarterly

 Current: Q2 2017

Column Description
ID The identifier for the ID type.
ID Type The insurance id type.
Other Issue Ogranization/entity issuing the ID.
State The state the ID is valid.

Diagnosis Breakdown - ICD-10 Category

The top 10 ICD-10 Categories by the percentage of total claims.

 Updated: Annually in the fall

 Current: 2016

Top 10 DRG

The top 10 Diagnosis-related groups (DRG) based on the total number of claims.

 Updated: Annually in the fall

 Current: 2016

Column Description
DRG Description The description of the DRG.
DRG Code The code for the DRG.
Total Claims The total number of claims for the DRG.
Total Percentage The percent of total claims for the DRG.
Total Charges The estimated total charges for the DRG.
Total Payments The estimated total payments for the DRG.
Medicare Claims The number of Medicare claims for the DRG.
Medicare Charges The total of Medicare charges for the DRG.
Medicare Payments The total of Medicare payments for the DRG.
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