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Medicare Physician & ServiceMedicare Physician & Other Practitioners — by Provider and Service
Centers for Medicare & Medicaid Services (CMS) · Tier-2 · profile-enrichment (renders on matched profiles)
The Medicare Physician & Other Practitioners by Provider and Service public-use file is procedure-level: one row per rendering NPI × HCPCS code × place of service for a data year. It reports beneficiaries, services, submitted charges, and Medicare allowed/payment amounts. Fonteum currently holds the latest published data year.
How this source shows up on Fonteum.
Per-NPI procedure-level Medicare utilization and payment, available via the read API and the dataset page. The NPI -> entity-graph link is a separate, gated follow-up — this source writes no entity rows — so utilization does not yet render on individual provider profiles.
What this source does NOT mean
Service volume and payment are Medicare fee-for-service utilization facts — they are not a measure of clinical quality, appropriateness, or outcomes, and a higher volume is not 'better.' Utilization is not a Fonteum assessment of the provider.
Research and data questions this source supports.
- Pull a provider's Medicare service mix — services, beneficiaries, and allowed/payment amounts per HCPCS code and place of service.
- Build a utilization benchmark that compares a provider's procedure volume against specialty peers.
- Research procedure-level Medicare spending by HCPCS code, place of service, and provider type.
- Power a provider-data API that returns procedure-level Medicare utilization per NPI.
Dataset size: 9,781,673 provider × service rows (2026-06-14 snapshot)
Per-field display contract.
Every field below has a `display_allowed` flag in the §94 provenance schema. Write-locked fields are captured to provenance for audit but never rendered on profile pages.
Research-only — never on profiles
9 fieldsWhat we can’t infer from this source.
- Service volume and payment are utilization facts, not a quality, appropriateness, or outcome measure.
- Annual cadence — the published data year lags the calendar year, and Fonteum holds the latest year only.
- NPI-keyed, but the entity-graph cross-link is deferred — utilization does not render on individual provider profiles yet.
- CMS suppresses low-volume cells; suppressed counts are stored as null, not zero.
Authority, license, refresh cadence.
Authority
Centers for Medicare & Medicaid Services (CMS)
Tier
Tier-2 · profile-enrichment (renders on matched profiles)
Refresh cadence
Annual — CMS publishes one public-use file per data year; Fonteum resolves the live release-dated CSV by the stable catalog UUID.
License
U.S. government public-domain works (17 U.S.C. § 105). Free to use with attribution. License ↗
Attribution requirement
Source: Centers for Medicare & Medicaid Services (CMS) — Medicare Physician & Other Practitioners by Provider and Service · Data Year {YYYY}
What the source allows.
U.S. government public-domain works (17 U.S.C. § 105). CMS publishes the public-use file as a no-auth bulk CSV per data year at data.cms.gov. This source is intentionally isolated from the separate cms-provider-utilization puller; the two do not share state. Fonteum resolves the live release-dated CSV by the stable catalog UUID and attests each snapshot.
What a single field looks like in the graph.
A worked example. Every field surfaced from this source carries this shape of provenance line — source · last checked · display rule · confidence (when applicable).
Field
Procedure-level utilization (research-only)
Sample value
NPI 1234567890 · HCPCS 99213 · Office · 240 services · allowed $92.40
Provenance line
Source: CMS Medicare Physician & Other Practitioners (by Provider and Service) · Data Year 2024 · Methodology medicare-physician-service/v1 · Display rule: per-NPI × HCPCS — read API + dataset page; profile rendering deferred with the entity-graph link
Official API, bulk download, and Fonteum endpoints.
Common questions about Medicare Physician & Service.
- What is the Medicare Physician & Other Practitioners by Provider and Service file?
- It is a CMS public-use file at the procedure level: one row per rendering NPI × HCPCS code × place of service for a data year. It reports distinct beneficiaries, total services, submitted charges, and Medicare allowed and payment amounts.
- Which data year does Fonteum hold?
- CMS publishes one file per data year; Fonteum holds the latest published data year (2024 in the current snapshot). As of the 2026-06-14 snapshot, the table holds 9,781,673 provider × service rows.
- Does high service volume mean better care?
- No. Service volume and payment are utilization facts, not a measure of clinical quality, appropriateness, or outcomes. A higher volume is not 'better,' and it is not a Fonteum assessment of the provider.
- Why are some values blank?
- CMS suppresses low-volume cells to protect beneficiary privacy. Fonteum stores suppressed counts as null, never as zero, so an absent value is not read as 'none.'
- How is this different from the provider-utilization puller?
- This source is intentionally isolated from the separate cms-provider-utilization pipeline — a different table and ingest — so the two do not share state. This one is procedure-level by provider and service.
Where this source already shows up.
Related sources in the graph
- /sources → The full source library — every dataset Fonteum cites.
- /data-provenance → The provider graph — pipeline diagram, source-family clusters, field-level provenance examples, display rules.
- /methodology → Network-wide sourcing, refresh cadence, and corrections policy.
- /editorial-policy → Independence, sourcing, conflicts, corrections, retractions.