The Provider file is one of a set of three file types (entity, provider, beneficiary) included for each model. A Provider is a Medicare provider/supplier who has an arrangement with an Entity to participate as a member of their entity group in a model.
What does this file include? (variable highlights)
- Model ID (in which the Provider participates)
- Entity ID (with which the Provider is associated)
- National Provider Identifier (NPI)
- Tax Identification Number (TIN)
- CMS Certification Number (CCN)
- Provider Start Date
- Provider End Date
- Provider Participation Type Code
The Entity ID is the only key field needed to link a Provider to their Entity.
The NPI, TIN, and/or CCN can be used to link to claims and other relevant CCW data.
A Provider may have an End Date of 12/31/9999, which indicates that the Provider is “currently” participating in the model.