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Spines

Physicians / Physician Groups Spines​

Notion: https://www.notion.so/turquoisehealth/Physicians-Physician-Groups-Spines-2a0b775c0e978039a8b7df02cdcbc113

Our Approach​

The primary source of truth for our Physician and Physician Groups spines tables is CMS’s PECOS data. Physician and Physician group Revalidation and Reassignment lists (here and here).

This PECOS data maintains a list of Medicare-registered physicians, their NPIs, specialties, and Individual PAC IDs. It also maintains a mapping of these physicians to the Physician Groups they’re registered with to Medicare.

With PECOS as the guiding light, and NPPES / Definitive / Komodo has helpful supplementary data sets, we did the following:

  • Create a master table of all Physician Groups from PECOS, filling in gaps from Definitive.
  • Create a master table of Physicians from NPPES, using PECOS and Definitive to fill in extra demographic info.
  • Map Physicians to Physician Groups using PECOS data
  • Map Physicians’ HCP NPIs to associated facilities using Komodo claims data
  • Extrapolate that Physician to Facilities mapping into Physician Group to Associated Facility mapping
  • Extrapolate Physician Group to Facility mapping into Physician Groups to Associated Health Systems

Tables​

spines_provider_physician_groups

  • Pulls from PECOS primarily, but takes group_pac_id and primary_npi from Definitive that may not exist in PECOS
  • provider_id is a unique identifier with a 1:1 to group_pac_id

spines_provider_physicians

  • Complete list of Type 1 NPIs is pulled from NPPES
  • Provider name, address, specialty, etc. taken from PECOS when available. If not, Definitive
  • provider_id is a unique identifier with a 1:1 to npi

spines_provider_physician_groups_physicians

  • Comes directly from the PECOS Revalidation list, which shows Physicians and the Physician Groups they’re registered with.
  • Maps PG provider_id to physician provider_id.
  • provider_id is a unique identifier with a 1:1 to group_pac_id

spines_provider_physicians_associated_facilities

  • Uses Komodo data to find the HCO NPIs found on the same claims as physician HCP NPIs. Finds the facilities where these physicians are most often found to be practicing
  • Caveat: This is only as good as our claims data. If we don’t have claims data for a given region or facility, there will be some false negatives.

spines_provider_physician_groups_associated_facilities

  • Uses the above mapping from physician to associated facilities, along with the Physician Group to Physician Mapping, to find the facilities each Physician Group is often billing with.

spines_provider_physician_groups_associated_health_systems

  • Uses the above Physician Group to Facility mapping to find the health systems associated with a given Physician Group. spines_provider_physician_groups_additional_npis

  • Links PG PAC IDs to PG NPIs and Associated PG NPIs using Pecos and Definitive

spines_provider_physician_groups_associated_tins

  • Links Physician Groups to TINs (PG to HCP to TIN) using MRF data

Resources​

Source PECOS Tables:​

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