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CMS Order & ReferringCMS Order and Referring
Centers for Medicare & Medicaid Services (CMS) · Tier-2 · profile-enrichment (renders on matched profiles)
The CMS Order and Referring file is the list of NPIs eligible to order and refer in Medicare, with a Y/N eligibility flag per benefit category (Part B, DME, Home Health, Power Mobility Devices, Hospice). One row per NPI, with last and first name. NPI is carried verbatim; the entity-graph cross-link is deferred.
How this source shows up on Fonteum.
Per-NPI Medicare order/refer eligibility, 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 eligibility does not yet render on individual provider profiles.
What this source does NOT mean
Order-and-refer eligibility is a Medicare administrative authorization — it does not indicate quality, outcomes, board certification, or appointment availability, and absence is not a negative quality signal. Eligibility is not a Fonteum assessment of the provider.
Research and data questions this source supports.
- Check whether an NPI is eligible to order and refer in Medicare, by benefit category (Part B, DME, Home Health, Power Mobility Devices, Hospice).
- Build a claims-integrity check that validates the ordering/referring NPI on a claim is eligible for that benefit.
- Cross-reference order/refer eligibility against the OIG LEIE to surface eligible-but-excluded providers for compliance research.
- Power a provider-data API that returns Medicare order/refer eligibility flags per NPI.
Dataset size: 2,008,019 enrolled providers (2026-06-14 snapshot)
Per-field display contract.
Fields listed below show their configured `display_allowed` flag from the §94 provenance schema. Fields marked write-locked are captured for audit and are not rendered on profile pages.
Research-only — never on profiles
8 fieldsWhat we can’t infer from this source.
- Eligibility is a Medicare administrative flag, not a quality measurement.
- NPI-keyed, but the entity-graph cross-link is deferred — eligibility does not render on individual provider profiles yet.
- The file republishes roughly weekly; eligibility changes lag the live CSV by up to one publication cycle.
- Absence from the file is not a negative signal — many providers are not order/refer-eligible by enrollment type.
Authority, license, publisher cadence.
Authority
Centers for Medicare & Medicaid Services (CMS)
Tier
Tier-2 · profile-enrichment (renders on matched profiles)
Publisher / configured cadence
Declared or configured cadence: Roughly weekly — CMS republishes the Order and Referring file under a release-dated path. Not evidence of the latest loaded source date.
License
U.S. government public-domain works. Free to use with attribution; explicit redistribution rights. License ↗
Official URL
Attribution requirement
Source: Centers for Medicare & Medicaid Services (CMS) — Order and Referring · Snapshot {YYYY-MM-DD}
What the source allows.
U.S. government public-domain works. CMS publishes the Order and Referring file as a no-auth bulk CSV at data.cms.gov with explicit redistribution rights. Snapshot and attestation fields must be read from the specific artifact; no provenance fact currently links deterministically to a signature.
What a single field looks like in the graph.
This worked example shows the provenance shape used when a surfaced field has populated source, last-checked, display-rule, and confidence metadata. Individual fields may omit unavailable values.
Field
Order/refer eligibility (research-only)
Sample value
NPI 1063717142 · Part B: Y · DME: Y · HHA: Y · Hospice: N
Provenance line
Source: CMS Order and Referring · Snapshot 2026-06-14 · Methodology cms-order-referring/v1 · Display rule: per-NPI eligibility — read API + dataset page; profile rendering deferred with the entity-graph link
Official API, bulk download, and Fonteum endpoints.
Official API / download
Fonteum surface
Common questions about CMS Order & Referring.
- What is the CMS Order and Referring file?
- It is the CMS list of NPIs eligible to order and refer in Medicare, with a Y/N eligibility flag per benefit category — Part B, Durable Medical Equipment, Home Health Agency, Power Mobility Devices, and Hospice. There is one row per NPI, with last and first name.
- How often does it update and where is it published?
- CMS republishes the file roughly weekly at data.cms.gov as a no-auth bulk CSV under a release-dated path. Fonteum resolves the live CSV by the stable dataset UUID and attests each snapshot. As of the 2026-06-14 snapshot, Fonteum holds 2,008,019 order/refer-eligible providers.
- Does eligibility render on provider profiles?
- Not yet. Order/refer eligibility is available via the read API and the dataset page, but the NPI → entity-graph link is a separate, gated follow-up, so eligibility does not yet render on individual provider profiles.
- Is order/refer eligibility a quality signal?
- No. Eligibility is a Medicare administrative authorization. It does not indicate quality, outcomes, board certification, or appointment availability, and absence from the file is not a negative signal — many providers are not order/refer-eligible by enrollment type.
- How can I cite this data?
- Use 'Source: Centers for Medicare & Medicaid Services (CMS) — Order and Referring' with the snapshot date. It is U.S. government public-domain data with explicit redistribution rights.
Where this source already shows up.
Related sources in the graph
- /sources → The generated source-catalog subset — documented datasets Fonteum cites.
- /data-provenance → The provider graph — pipeline diagram, source-family clusters, field-level provenance examples, display rules.
- /methodology → Documented sourcing, publisher cadence, observed freshness, and corrections policy.
- /editorial-policy → Independence, sourcing, conflicts, corrections, retractions.