CCN and PAC ID to NPI: Crosswalk between the NPI Registry and Hospital and Group Records

The federal Centers for Medicare and Medicaid Services (CMS) publishes a wide range of information on U.S. hospitals, which all carry the unique identifier, the CCN number (CMS Certification Number)*. On the other hand (which often seems to not know what its counterpart is doing), CMS also publishes the frequently updated NPPES database (National Plan and Provider Enumeration System), commonly known as the NPI Registry, which uses the NPI number (National Provider Identifier) as its unique identifier. While hospitals and other medical organizations will have only one CCN Number, they are required to have at least one NPI number, and they're permitted to have as many as they like (and they do seem to like quite a few). 

And, between these two ID systems, the CCN and the NPI, ne'er the twain shall meet.

CarePrecise has developed a sophisticated system to "roll up" an organization's NPI-numbered records with its CCN number (and with the PAC ID for practice groups, which stands for "PECOS Associate Control ID"). This mighty trick produces some eye-opening data, such as contact names and titles, license information, specializations, market data added by CarePrecise to NPI records, and the ability to crossmatch groups to their members and hospital affiliations, directly from their NPI numbers. It also permits integration across the complete line of CarePrecise provider data packages, and all of the information that CarePrecise collects or creates and then merges to the NPI records.

Currently, these CarePrecise rollups (or "crosswalks" if you prefer) are the only available such thing in a relatively comprehensive dataset. The full rollup of all medical facility NPI numbers is available for hospitals, and a single "priority" NPI number is currently available for practice groups, with a full rollup of all PAC ID-to-NPI linkages in development with a tentative release date in May 2023.

The hospital CCN-to-NPI crosswalk is part of the Authoritative Hospital Database (APD), and the Group PAC ID-to-NPI link is part of the Authoritative Physician Database (APD) and CarePrecise Platinum.

The "rolling up" is made possible by several CarePrecise innovations, starting with the CoLoCode (co-location code) affixed to almost every provider in the 7 million+ record CarePrecise master reference database. To fill in additional linkages, The CarePrecise HealthGeo geocode dataset, containing latitude and longitude for all 8.5 million+ provider records, which can readily be used to link data between data suppliers for a variety of purposes.

* The CMS Certification Number has replaced the term Medicare Provider Number, Medicare Identification Number or OSCAR Number. The CCN is used to verify Medicare/Medicaid providers for survey and certification, assessment-related activities and communications. Note that CarePrecise includes the old OSCAR Number in its CarePrecise Complete and CarePrecise Advanced/Platinum datasets, if reported by the provider in their NPI record(s) or available through third-parties, but this is a small fraction of records, and the OSCAR numbers have changed, hence the need for a CCN-to-NPI crosswalk.

Out of the Silos: Combined Healthcare Provider Data

You always knew it was possible to get all of the rich federal data on healthcare providers together in one place, and in a form you could use on your PC. And you were simply ecstatic when CMS released the NPPES database! But then you downloaded it and learned that there is simply no normal desktop software that can make that data accessible to you. Rats!

Then CarePrecise created a version of that data -- our flagship product, CarePrecise Access Complete (CPAC), so you could use all 4 million provider records on your computer. Yay! But then you found that it was hard to get around in all that data. Rats! So CarePrecise released the CP ListMaker software that makes getting at the data you want a walk in the park. Excellent! And you wanted some way to know which providers were sanctioned, or that they were eligible to bill Medicare, so CarePrecise integrated data from the PECOS (Medicare) database and the LEIE (List of Excluded Individuals and Entities). Fantastic!

Then you wanted more than the single practice location and fuzzy practice group data that the NPPES gave you, so CarePrecise integrated all of the Physician Compare data with CPAC. Cool! And you wondered how would you ever tame all of that hospital data, so CarePrecise integrated a de-duplicated list of hospitals and the Hospital Compare data, and while we were at it, we included hooks into the hospital quality data and the upcoming physician quality data. And all of it -- the NPPES, PECOS, LEIE, Physician Compare, Hospital Compare (plus some really nice additional stuff like proper-cased name and address fields, provider service area wealth data, and urban/rural/suburban designations) -- all integrated into a single relational database, linked by the NPI number. And you though it couldn't be done.

Now we call that sweet package of data heaven by a weird name: The CarePrecise Total Bundle. And as we integrate upcoming federal data releases, will we be tucking them in there too? You betcha. That's what CarePrecise is all about: healthcare provider data integration and application.

It's brand new and available now: The only 360 degree view of U.S. healthcare provider data. Total Bundle pricing is just $689. That's less than 2/100ths of a penny per record for the most complete physician database / hospital database / dentist database... available anywhere.

You're welcome!

HIPAA-Covered Providers Top 4 million

With the August, 2013 data release, a new milestone has been reached in the U.S. healthcare industry. There are now 4,021,049 healthcare providers covered under HIPAA, of which 900,126 are physicians.

Over 1 million entities, mostly physicians and physician groups, are enrolled to bill Medicare, according to the PECOS Ordering and Referring report.

Added just this month were 30,578 new NPI records. Over the past 60 days, changes were made by healthcare providers on 127,972 NPI records.

The CarePrecise Access Complete dataset includes all of these records.

The Sunshine List

As lawmakers continue to push CMS to implement the Physician Payments Sunshine Act, and CMS mildly demurs out of concern that drug and equipment manufacturers won't be able to comply any time soon, CarePrecise has been busy getting prepared for a run on the databank.

As most of the players are beginning to realize, an accurate and up-to-date source of provider information will be a necessity in reporting payments properly. The CarePrecise master provider list contains all the hooks required to positively identify specific providers, and connects provider licensing and NPI numbers to such pertinent information as PECOS enrollment, Medicare billing eligibility, and the Office of Inspector General's excluded providers database. The current version of the CarePrecise Access Complete database identifies multiple providers practicing at a single location, using super-conformed location coding.

Sunshine Incoming

CarePrecise can process incoming lists of payments to providers using the advanced record-linking technology we use to build our master databases. Whether companies have NPI numbers or not, our system can use other data to identify payees.

CarePrecise data is already in use is installations where states have various types of Sunshine laws in place, and where organizations are preparing for the federal act to take effect. When we can all finally see who's paying what to whom (to whatever extent that will be truly possible), CarePrecise data will be part of this vital next step in controlling healthcare costs and abuses of influence.

Practice Group Data Now Part of CP ListMaker

Jan. 29, 2012 -- CarePrecise announces a major upgrade of its  CP ListMaker software that puts all 3.5 million U.S. healthcare provider records – including almost one million physicians – in reach for marketers. Now includes practice group data to help qualify sales leads.

Today we announced a new version of our popular CP ListMaker software, our desktop system that puts all of the 3.5 million healthcare provider records – including approximately one million physicians and tens of thousands of hospitals and ambulatory care facilities – at the fingertips of researchers and marketers. CP ListMaker allows users to pull tightly targeted lists of physicians and other providers based on criteria such as specialty, subspecialty, facility types for organizations, provider gender, wealth/poverty of service area, Medicare enrollment, and many more. The new version, CP ListMaker 3.5, unveils new practice group data, and does it in an interesting way.

Until now, it has been difficult to find data indicating provider’s practice groups. With new data now obtained from Centers for Medicare and Medicaid Services (CMS), combined with CarePrecise’s advanced record linkage system, CP ListMaker identifies practice groups, and can list all of the providers working at each practice location. 

The “Co-location codes” attached to each record make it possible to further qualify potential prospects for companies marketing to the medical community. Not only physician practices, but dental groups, behavioral services groups, and all other HIPAA-covered healthcare providers are co-location coded. The new CP ListMaker offers tools for using the new data. For example, to export a list of obstetric/gynecology group practices of between 3 and 20 members.

CarePrecise’s record correlation processes also make it possible to link providers’ PECOS and LEIE records with their NPI (National Provider Identifier) records ( http://www.careprecise.com/pecos-npi ), providing a rich master record ( http://www.careprecise.com/provider-data-linkage.htm ) that can be used to enrich or update customers’ existing databases. The PECOS data (indicating which providers are enrolled to be able to bill Medicare) has recently been redacted by CMS, now providing only a partial NPI number; however, our system restores the full NPI number. The federal List of Excluded Individuals/Entities (LEIE) database, which lists providers who have been barred from billing federal programs due to fraud convictions or other infractions, also has no unique identifier as distributed; however, CarePrecise links the LEIE data to the NPI data with each monthly update.

With or without a unique identifier, such as an NPI, EIN, UPIN or OSCAR -- or even a telephone number -- the CarePrecise master data management system, known as QoRelate® (http://www.careprecise.com/provider-data-linkage.htm ), can pull provider data together into a master record database from diverse sources. The company offers boutique record linkage services that can be used to merge data acquired during mergers and acquisitions, through cooperatives such as Health Information Exchanges, or from multiple in-house systems.

CP ListMaker is available as part of the CarePrecise Gold bundle, which includes CP ListMaker and the full U.S. healthcare provider database, or separately for customers who already subscribe to the CarePrecise data. The tool runs in Microsoft Access 2003, 2007 and 2010, and is provided open source, making all of the Access tools available to users.

RESOURCES:

CP ListMaker healthcare provider research and market targeting tools:
http://www.careprecise.com/cplistmaker

 

QoRelateMaster Data Management & Record-Linkage:
http://www.careprecise.com/provider-data-linkage.htm  

CarePrecise Gold (complete U.S. healthcare provider database with marketing and research tools):
http://www.careprecise.com/gold

 

Contact CarePrecise:
http://www.careprecise.com/contact

A Nut Too Tough to Crack?

One of the hardest problems in health IT is the effort to get data from different silos into a centralized database that can be searched as a single dataset. So, this is us announcing our new "linking and shrinking" technology, code named "Squirrel." What does it do?

Squirrel is a record-linkage and deflation system that pulls in data from multiple federal provider databases in various formats, makes them play nice together by linking everything up under providers' NPI numbers, preserves all the data but shrinks the file size down to about 9% of the original size, puts it in a format that can be managed in Microsoft Access or other garden variety database software, downloads it to our customers, and then does it all again fresh every month.

The technology is built on record-linkage methods developed over twenty years. Interesting trivia: The precursor to the current system was built in Microsoft Access 1.0 -- you remember it, the Introductory Package -- in 1992. While we don't share all the secrets, the basic trick involves pattern matching algorithms and a lot of processing time to handle more than 13 million rows of data, comparing each provider's records between all the sources. The end result is called CarePrecise Access.

We just sent out a press release about the whole thing.

Now you'll excuse us, as we have some more nuts to collect and crunch on.