NPPESNational Plan and Provider Enumeration System (US DHHS)
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Linking NPPES data to other CMS datasets that are updated more routinely than NPPES, and to the AMA Masterfile, which receives information directly from training institutions, could potentially improve the validity of the information in NPPES and thereby make it more valuable for workforce analysis.
Although there are a number of overlapping variables, the application process for a provider to be entered into the PECOS system, to be eligible to bill CMS for health care services, is independent of the NPI application process through NPPES.
Like the NPPES application, the PECOS application asks providers to report their name, credentialing degree, gender, date of birth, birth location, social security number, business tax identification number, business address, business phone, license number, and state where the license was issued.
Unlike NPPES, providers are required to revalidate their information in PECOS every five years.
Thus, scheduled updates of information, as well as the linking of information in PECOS to the claims process, makes it more likely that PECOS contains more up to date information on provider specialty than NPPES. The PECOS database is not currently available for research purposes outside of the U.S.
However, for many of these providers, it may be possible to use the NPI in Medicaid claims to link to the specialty information in NPPES, and to use this information either alone or in combination with procedure and place of service codes in the Medicaid claims to characterize these providers' specialties.
The AMA Masterfile has been the most widely used data source for health care workforce studies, but NPPES and the associated NPI could prove to be more useful over time.
Neither NPPES, nor the AMA Masterfile, has an adequate system in place to assure that the information is up to date.