Physician Compare Data FAQ

This section answers frequently asked questions from physician and other health care professionals about administrative data available on Physician Compare. If you have questions about updating your information on Physician Compare, please visit the section How to Update Your Data on Physician Compare. Select the question below to view the corresponding answer.

You are welcome to send feedback and questions to the Physician Compare team at PhysicianCompare-Helpdesk@AcumenLLC.com.

Physician Compare Data Source

What is Physician Compare’s primary data source?
When did Physician Compare start using Medicare claims data to verify PECOS?
Are all individual health care professionals and group practices listed on Physician Compare?
How is an individual health care professional or group practice address determined?
How is group practice affiliation determined on Physician Compare?
How is hospital affiliation determined on Physician Compare?
How is residency and board certification information determined on Physician Compare?
How is Medicare Assignment status determined for Physician Compare?

Specialties on Physician Compare

How are specialties designated on Physician Compare?
Can additional medical specialties be included on the website?
How is the list of specialties in the drop-down boxes on Physician Compare determined?

Downloadable Database

Is there a downloadable database of all the information currently available on Physician Compare?
What is included in the downloadable file?

Other Data on Physician Compare  

I would like my fellowship training added to my profile page. Is this possible?
We would like to have our web address displayed next to our physicians’ names on Physician Compare. Is this possible?
Who do I contact if I have suggestions for information to include on Physician Compare?

Physician Compare Data Source

What is Physician Compare’s primary data source?

Physician Compare’s underlying data source is PECOS. PECOS is Medicare’s enrollment and revalidation system. It is the sole verified source of Medicare data.

When did Physician Compare start using Medicare claims data to verify PECOS?

Physician Compare began using Medicare claims data to verify PECOS information in mid-2013. PECOS is Medicare’s enrollment and revalidation system and therefore it is the primary source of information about verified Medicare professionals. However, PECOS is an enrollment system and it is not intended to provide up-to-the-minute information for a consumer website like Physician Compare. Therefore, we use Medicare claims data to verify the information in PECOS. We primarily use claims to verify group practice affiliations and practice locations.

Are all individual health care professionals and group practices listed on Physician Compare?

No. Not every individual or group practice in PECOS is included on Physician Compare. In order to be included on the site, individual health care professionals must also:

  • Have at least one practice location address in PECOS
  • Have at least one specialty in PECOS
  • Have submitted a Medicare claim within the last 12 months or be newly enrolled in PECOS within the last 6 months

For group practices to appear on Physician Compare, at least two active Medicare eligible professionals (EPs) must reassign their benefits to the group’s TIN.

How is an individual health care professional or group practice address determined?

Individual or group practice address is determined by cross-referencing PECOS and claims data. This ensures that only those practice location addresses where a professional is currently providing services are included on the website. For example, if a practice only uses one location as their billing address, then this will be the only location displaying for every affiliated professional. This process is described in more detail below.  

Individual health care professional as a solo practitioner:

  • Practice location for solo practitioners comes from the individual’s PECOS enrollment. Only the Physical Location and “Special Payments” addresses may appear on Physician Compare. Correspondence address will not be published on the website. To ensure that only those addresses where a professional is currently billing are included on the website, Physician Compare cross-references the individual’s PECOS locations and Medicare claims submitted in the previous 12 months.  Physician Compare will only display the PECOS practice locations that match the ZIP code included on claims. On CMS-1500 claims form, this is Box 32 (Service Facility Location Information).
  • If an individual is newly enrolled in Medicare, the practice locations are exempt from the claims verification process for the first 6 months. These practice locations will be automatically included on Physician Compare. After 6 months, claims verification is required.

Individual health care professional as part of a group practice:

  • When an individual health care professional reassigns their benefits to a group TIN, the group practice locations will be associated with that individual. To refine this list, individuals can log into Internet-based PECOS to review the group practice addresses and select their primary and secondary practice locations.
  • If primary and secondary practice locations are not identified in PECOS, Physician Compare will cross-reference the group practice PECOS locations and Medicare claims submitted in the previous 12 months.  Physician Compare will only display the PECOS practice locations that match the ZIP code included on claims. On CMS-1500 claims form, this is Box 32 (Service Facility Location Information).

How is group practice affiliation determined on Physician Compare?

Physician Compare determines group practice affiliation by cross-referencing PECOS and fee-for-service Medicare claims. An individual health care professional must reassign their benefits to a group practice TIN. Then, Physician Compare references claims data to ensure the professional is currently billing to the TIN.

A group practice affiliation will only be listed on the site if:

  • There was at least one claim filed in the past year with the health care professional and group practice’s NPI/TIN combination, OR
  • It was created in the last 6 months, AND
  • Both the health care professional that reassigned their benefits and the group are in “approved” status.

How is hospital affiliation determined on Physician Compare?

Hospital affiliation is identified through self-report as well as inpatient hospital, outpatient hospital, and physician and ancillary service claims. In all cases, the health care professional must provide services to at least three patients on at least three different dates in the last 12 months.

For inpatient and outpatient hospital claims, a link between a health care professional and a hospital is made if the professional’s NPI appears on a claim for the hospital.

For physician and ancillary service claims, services rendered in a hospital are identified based on the place of service code on the claim. The specific hospital is identified through a link to the patient by evaluating where the patient was hospitalized at the time.

How is residency and board certification information determined on Physician Compare?

Residency and board certification information is obtained from a database compiled by Elsevier in cooperation with the American Board of Medical Specialties (ABMS). At this time, only certification information from approved member boards of the ABMS is displayed on Physician Compare.

How is Medicare Assignment status determined for Physician Compare?

All physicians and other health care professionals on Physician Compare accept Medicare. However, they don't all bill Medicare the same way. If a professional accepts Medicare Assignment, they agree to be paid directly by Medicare, to accept the Medicare approved payment amount, and not to bill patients more than the Medicare deductible and coinsurance.

Both group practices and individual health care professionals identify their Medicare Assignment status when they enroll in Medicare. Medicare Assignment Status can only be updated during the open enrollment period, which is generally from mid-October through December each year. To determine the exact dates when you can update this status, please contact your MAC or carrier.

Medicare Assignment is indicated on Physician Compare with either an “Accepts Medicare Assignment” icon or a “May Accept Medicare Assignment” icon. It is important to note that for all groups and professionals with a “May Accept Medicare Assignment” icon, the website encourages beneficiaries to call and confirm this status before seeking any services.

The Medicare Assignment icon that displays on individuals’ profile page varies depending on their PECOS enrollment. If the individual is a solo practitioner, Medicare Assignment status is determined by what he/she selected in PECOS or indicated on the Medicare Participating Physician Agreement form.

However, if the individual is a member of a group practice, then the following rules apply:

  • If the individual and the group practice have the same assignment status, then that status will be displayed on the individual’s profile page as well as the group’s profile page.
  • If the individual does not indicate an assignment status but reassigns their benefits to a group that does accept Medicare Assignment, then an “Accepts Medicare Assignment” icon is placed on the individual and group practice profile page.
  • If the individual indicates he/she accepts Medicare Assignment and reassigns their benefits to a group that does not accept assignment, then a “May Accept Medicare Assignment” icon is displayed on the individual profile page.
  • If an individual is both a solo and group practitioner with conflicting assignment statuses, then “May Accept Medicare Assignment” is displayed on the individuals profile page.

[Back to top]

Specialties on Physician Compare

How are specialties designated on Physician Compare?

Primary and secondary specialties on Physician Compare come from PECOS.  When enrolling in Medicare, health care professionals must select a specialty on the 855i Medicare Enrollment Form. These include physician specialties such as Family Practice or Cardiovascular Disease (Cardiology) and other health care professional categories such as Nurse Practitioner and Clinical Psychologist.

Can additional medical specialties be included on the website?

Specialty designations and sub-specialty designations beyond what is captured on the 855i form are not available for inclusion on Physician Compare.

How is the list of specialties in the drop-down boxes on Physician Compare determined?

The specialties on Physician Compare are the same as the 855i Medicare Enrollment Form. The specialties in the drop-down box are mapped to search terms through the Intelligent Search feature. This allows a user to enter a specialty name, body part, organ system, or condition and a list of suggested specialties will be displayed. If multiple specialties are related to a search term, they will be listed in alphabetical order to ensure they are presented in a way that does not indicate one is more prevalent than the other.  CMS contractors work closely with specialty societies to build and refine these specialty suggestions. This process is ongoing as we continue to improve and enhance this functionality. If you have questions or concerns with the functionality, contact the Physician Compare team.

[Back to top]

Data Display and Downloadable Databases

Is there a downloadable database of all the information currently available on Physician Compare?

Downloadable databases are currently available on data.medicare.gov. These datasets include general information, such as demographic information and Medicare quality program participation, for individual EPs.

What is included in the downloadable file?

The downloadable file is organized at the individual EP level, with unique lines for the professional, enrollment, Group Practice or address level. Professionals affiliated with multiple group practices are listed on multiple lines for each group PAC ID. Additional datasets are included for the 2013 PQRS GPRO performance rates for the three Diabetes Mellitus measures and one Coronary Artery Disease measure now publicly reported on Physician Compare. ACO quality data are available in downloadable files available via data.cms.gov for Shared Savings Program ACOs and via cms.gov for Pioneer ACOs.

[Back to top]

Other Data on Physician Compare

I would like my fellowship training added to my profile page. Is this possible?

At this time we are unable to display fellowships, chief residencies or internships on Physician Compare. We will evaluate the possibility of including such information on the site in the future.

At this time we are not displaying web addresses on the Physician Compare website. We will evaluate the possibility of including such information on the site in the future.

Who do I contact if I have suggestions for information to include on Physician Compare?

CMS values suggestions from website users on ways to improve Physician Compare. You can email feedback and/or questions to the PhysicianCompare-Helpdesk@AcumenLLC.com

[Back to top]

Page Last Modified:
12/04/2019 03:16 PM