U.S. Department of Health & Human Services

Medicare Physician & Other Practitioners

Name: Medicare Physician & Other Practitioners
Creator: U.S. Department of Health & Human Services

A directory of physicians and other practitioners enrolled in the U.S. Medicare program. Each record includes the practitioner's first name, last name, primary and secondary business names, street address, city, state, and zip code.

Example records

Nameperson	Alternate Nameadditional data	Cityaddress	Stateaddress	ZIP Codeaddress	Street Addressaddress	Rndrng Npiregistration	Rndrng Prvdr Miperson	Rndrng Prvdr Crdntlsrole	Rndrng Prvdr Ent Cdclassification	Rndrng Prvdr State FIPSgeographic	Rndrng Prvdr Rucageographic
DESCHENES	MS:M4-PFS	SEATTLE	WA	98101	1100 9TH AVE	1992999825	R	M.D.	I	53	1
JOFFE	MOB 2, SUITE 319	MECHANICSVILLE	VA	23116	8260 ATLEE RD	1992999874			I	51	1
MAREK		WILLIAMSPORT	PA	17701	1355 FOUR MILE DR	1992999585	F	D.C.	I	42	1

Use cases

Provider Identity Verification for KYB Onboarding

A fintech company onboarding healthcare providers onto a payment or lending platform cross-references the applicant's NPI, credentials, and practice address against this dataset to confirm the provider is a real, Medicare-enrolled practitioner operating at the stated location.

Rndrng NpiRndrng Prvdr CrdntlsStreet AddressCityState

Anomalous Billing Pattern Detection

A fraud analytics team at a health insurance company flags providers whose total submitted charges are far above the Medicare allowed amount relative to peers in the same specialty and geography, identifying candidates for claims audit or network removal.

Rndrng NpiRndrng Prvdr TypeTot Sbmtd ChrgTot Mdcr Alowd AmountTot Mdcr Pymt Amount

Specialty-Level Market Sizing for Medical Device Sales

A medical device company's sales operations team estimates the addressable market for a new surgical tool by counting active Medicare-participating providers in the relevant specialty, grouped by state and urban versus rural classification, to prioritize territory assignments.

Rndrng Prvdr TypeRndrng Prvdr Mdcr Prtcptg IndStateRndrng Prvdr Ruca DescriptionTot Srvcs