NPPES Provider Search & Utilization
Search physicians & clinicians across the NPPES registry and analyze multi-year CMS Part B procedure counts categorized by CPT range.
Matching Providers 0
Enter search criteria above or choose a sample to find clinicians.
Dr. Provider Name
Individual (Type 1)Annual Procedure Volume Trend
Medicare Part B Services (Beneficiary $\ge$ 11)Detailed Procedure History
Breakdown of procedures by reporting year, volume, and clinical service type. Fee-For-Service Part B only.
| Year ↕ | HCPCS Code ↕ | Category ↕ | Description ↕ | Services ℹ️ ↕ | Beneficiaries ℹ️ ↕ | Place ℹ️ ↕ | Avg Allowed ℹ️ ↕ |
|---|---|---|---|---|---|---|---|
Top Provider Procedure Leaderboard
Look up any CPT/HCPCS procedure code to discover the highest-volume providers nationally or within a specific state.
Arthroscopy, shoulder, surgical; repair of SLAP lesion
| Rank ↕ | Provider / Clinician ↕ | NPI ↕ | Specialty / Taxonomy ↕ | Location ↕ | Procedure Count ℹ️ ↕ | Volume Comparison | Beneficiaries ℹ️ ↕ | Avg Allowed ℹ️ ↕ | Action |
|---|---|---|---|---|---|---|---|---|---|
Top Quality Clinician Leaderboard (By MIPS Measure)
Identify the highest-quality performing clinicians nationally or by state on specific MIPS clinical measures, ranked by CMS Star Rating (⭐⭐⭐⭐⭐), Performance Rate %, and Patient Count.
Diabetes: Eye Exam
| Rank ↕ | Clinician / Provider ↕ | NPI ↕ | Specialty ↕ | Location ↕ | CMS Star Rating ℹ️ ↕ | Performance Rate ℹ️ ↕ | Patient Count ℹ️ ↕ | Action |
|---|---|---|---|---|---|---|---|---|
Clinician MIPS Scorecard Lookup
Search any clinician by Specialty, Name, Location, or direct NPI to inspect their overall MIPS composite performance and reported measures.
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Individual ReportingCMS MIPS Composite Performance Scorecard
Performance Year (PY) 2024 Merit-based Incentive Payment System Evaluation
Reported Quality Measures & Star Benchmarks
0 MeasuresClinical quality measures submitted under MIPS performance programs. Click any row to view multi-year historical trajectory.
| Measure Code ↕ | Category ↕ | Clinical Quality Measure Title ↕ | Collection Type ↕ | Patient Count ℹ️ ↕ | Performance Rate ℹ️ ↕ | Direction ℹ️ | CMS Star Rating ℹ️ ↕ | Trend |
|---|---|---|---|---|---|---|---|---|
No MIPS Quality Data Found
No Performance Year (PY) 2024 MIPS public reporting records were found for this NPI. Under CMS rules, clinicians may be exempt from MIPS reporting if they qualify for the Low-Volume Threshold (< $90k Medicare allowed or < 200 Medicare Part B patients) or are in their first year of Medicare participation.
Diabetes: Eye Exam
Annual historical quality benchmark and performance rate trajectory across reporting years.
Multi-Year Performance Rate Trajectory
MIPS Performance Rate %| Performance Year | Rate / Score | CMS Star Rating | Cohort Benchmark | Trend Status |
|---|
Understanding CMS Medicare Data & Counting Rules
Essential clinical and regulatory principles explaining Medicare procedure counts, privacy thresholds, and quality benchmarks.
1. Fee-For-Service (Part B) Only — Why Counts Look Lower
Understanding payer mix and commercial exclusion
Clinicians reviewing CMS data frequently ask: "I performed 120 total joint replacements or rotator cuff repairs this year. Why does CMS only show 26?"
- Medicare Advantage (Part C) is Excluded: Approximately 45% to 50% of all Medicare beneficiaries nationally (and in Oklahoma) are enrolled in private Medicare Advantage plans (e.g. UnitedHealthcare MA, Humana, Aetna MA, BCBS Medicare Advantage). Claims processed by Medicare Advantage plans are not included in this dataset.
- Commercial Insurance is Excluded: All private commercial insurers (Blue Cross Blue Shield, UnitedHealthcare, Aetna, Cigna), workers' compensation, and self-pay patients are excluded.
- Medicaid is Excluded: Medicaid / SoonerCare claims are not included.
- Typical Practice Share: In an active surgical or specialty practice, Original Medicare Part B typically accounts for only 20% to 35% of the clinician's total surgical volume. A count of 25–35 procedures in this dataset is completely normal and mathematically consistent with an active practice doing 100+ total cases annually.
2. CMS HIPAA Privacy & Suppression Rule (≤ 10 Beneficiaries)
Why low-volume procedures are completely redacted from public reporting
Under federal HIPAA privacy guidelines and CMS cell-size suppression rules, any procedure performed for 10 or fewer Medicare beneficiaries in a calendar year is completely redacted and excluded from the by-procedure dataset to prevent patient re-identification.
The 181-service difference represents procedures where Dr. Stotler treated 10 or fewer patients. While credited in his aggregate Medicare volume, the specific procedure lines were redacted by CMS for patient privacy.
3. Place of Service Splitting (Facility vs. Office)
Separate rows for hospital OR/ASC vs. private outpatient clinics
CMS reports procedure records separately by Place of Service:
- Facility (F): Procedures performed in an Inpatient Hospital, Hospital Outpatient Department (HOPD), or Ambulatory Surgical Center (ASC).
- Office (O): Services performed in a physician's private office or non-facility clinic.
If a doctor performs consultations (e.g. 99214), diagnostic injections, or minor procedures in both settings, CMS splits the volume across two separate rows rather than combining them into one.
4. CMS MIPS Quality Scoring & Decile Benchmarks
How Star Ratings, Performance Tiers, and Inverse Measures work
- CMS Star Ratings (⭐⭐⭐⭐⭐): MIPS star ratings (1 to 5 Stars) are based on historical decile benchmarks established by CMS across all reporting clinicians nationwide. A 5-star rating indicates top-decile performance (≥ 90th percentile).
- Individual vs. Group Practice Reporting: Clinicians who participate through a multispecialty group practice (e.g. Tulsa Bone and Joint Associates PC) report under their group's Tax Identification Number (TIN) / PAC-ID. In accordance with CMS policy, all clinicians in the group share the group's validated performance rate and composite scorecard.
- Inverse Measures (Lower is Better): For patient safety measures like surgical complications, postoperative readmissions, or poor diabetic control (HbA1c > 9%), a lower percentage rate reflects higher clinical quality. Our profiler automatically highlights these with an amber Lower is Better tag.
5. Zero-Cap Guarantee — Complete API Pagination
Technical assurance that no records are omitted or truncated
Our application backend communicates directly with the CMS Open Data API and Provider Data Catalog using automated offset pagination loops:
- Every provider request paginates iteratively until the end of available records (
offset += page_size), ensuring zero capping or truncation. - Whether a clinician has 10 procedure records or a high-volume diagnostic laboratory has 3,000+ distinct lines, 100% of all public CMS records are fetched, categorized, and displayed.