Provider Data Catalog: Doctors and Clinicians Data Dictionary
Performance Year 2021
This data dictionary describes the seven Doctors and Clinicians downloadable data files available in the Provider Data Catalog (PDC)
for performance year (PY) 2021 of the Quality Payment Program and calendar year 2020 for the utilization data. The data files
include:
• Demographic data describing individual doctors and clinicians (one file);
• Clinician, group, and virtual group Merit-based Incentive Payment System (MIPS) performance information (four files);
• Clinician overall MIPS Final Score and performance category score information (one file); and
• Clinician utilization data (one file).
Table of Contents
National Downloadable File (DAC_NationalDownloadableFile.csv)
The Doctors and Clinicians national downloadable file is organized such that each line is unique at the
clinician/enrollment record/group/address level. Clinicians with multiple Medicare enrollment records
and/or single enrollments linking to multiple practice locations are listed on multiple lines.
Facility Affiliation Data (Facility_Affiliation.csv)
This is the facility affiliations data publicly reported in the Provider Data Catalog.
PY 2021 Clinician Public Reporting: MIPS Measures and Attestations (ec_public_reporting.csv)
This file contains performance information for Merit-Based Incentive Payment System (MIPS) Quality,
Promoting Interoperability, and Improvement Activities performance information submitted by clinicians.
PY 2021 Clinician Public Reporting: Overall MIPS Performance (ec_score_file.csv)
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This file contains Merit-Based Incentive Payment System (MIPS) Final Scores and performance category
scores for clinicians. For further details on 2021 MIPS scoring, see the 2021 Traditional MIPS Scoring
Guide.
PY 2021 Group Public Reporting: MIPS Measures and Attestations (grp_public_reporting.csv)
This file contains performance information for Merit-Based Incentive Payment System (MIPS) Quality,
Promoting Interoperability, and Improvement Activities performance information submitted by groups.
PY 2021 Group Public Reporting: Patient Experience (grp_public_reporting_cahps.csv)
This file contains performance information for the Consumer Assessment of Healthcare Providers and
Systems (CAHPS) for MIPS measures submitted by groups.
PY 2021 Virtual Group Public Reporting: MIPS Measures and Attestations (vg_public_reporting.csv)
This file contains performance information for Merit-Based Incentive Payment System (MIPS) Quality,
Promoting Interoperability, and Improvement Activities performance information submitted by virtual
groups.
2020 Clinician Utilization Data (ClinicianUtilization_2020.csv)
This is the clinician utilization data publicly reported in the Provider Data Catalog. This is a subset of the
2020 Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, listed as
Healthcare Common Procedure Coding System (HCPCS) codes.
Additional Information
This page provides reasons why the downloadable files may not exactly match the information as
displayed on Medicare Care Compare profile pages.
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Doctors and Clinicians National Downloadable File
The Doctors and Clinicians national downloadable file is organized at the individual clinician level; each line is unique at the clinician-
enrollment record-group-address (NPI-Ind_enrl_ID-Org_PAC_ID-adrs_id) level. Clinicians with multiple Medicare enrollment records
and/or single enrollments linking to multiple practice locations are listed on multiple lines.
Variable Name Variable Label Description Length Values
Professional Identification
NPI NPI Unique clinician ID assigned by NPPES 10 string
Ind_PAC_ID PAC ID Unique individual clinician ID assigned by PECOS 10 string
Unique ID for the clinician enrollment that is the source 15 string
Ind_enrl_ID Clinician Enrollment ID
for the data in the observation
lst_nm Last Name Individual clinician last name 35 string
frst_nm First Name Individual clinician first name 25 string
mid_nm Middle Name Individual clinician middle name 25 string
suff Suffix Individual clinician suffix 10 string
gndr Gender Individual clinician gender 1 M/F/U
Medical Credentials
Cred Credential Medical credential such as MD, DO, DPM, etc. 3 string
Med_sch Medical school name Individual clinician’s medical school 100 string
Grd_yr Graduation year Individual clinician’s medical school graduation year 4 numeric
Pri_spec Primary specialty Primary medical specialty reported by the individual 60 string
clinician in the selected enrollment
Sec_spec_1 Secondary specialty 1 First secondary medical specialty reported by the 60 string
individual clinician in the selected enrollment
Sec_spec_2 Secondary specialty 2 Second secondary medical specialty reported by the 60 string
individual clinician in the selected enrollment
Sec_spec_3 Secondary specialty 3 Third secondary medical specialty reported by the 60 string
individual clinician in the selected enrollment
Sec_spec_4 Secondary specialty 4 Fourth secondary medical specialty reported by the 60 string
individual clinician in the selected enrollment
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Variable Name Variable Label Description Length Values
Sec_spec_all All secondary specialties All secondary medical specialty reported by the 200 string
individual clinician in the selected enrollment
Medical Practice
Telehlth Telehealth Indicator for whether clinician offers telehealth services 1 Y
over video and/or audio
Y = Medicare fee-for-service claims indicate that
clinician offers telehealth services
Org_nm Organization legal name Legal name of the group that the individual clinician 70 string
works with – will be blank if the address is not linked to
a group
Org_PAC_ID Group PAC ID Unique group ID assigned by PECOS to the group that 10 string
the individual clinician works with – will be blank if the
address is not linked to a group
num_org_mem Number of group Total number of individual clinicians affiliated with the 8 numeric
members group based on Group Practice PAC ID
adr_ln_1 Line 1 Street Address Group or individual's line 1 address 55 string
adr_ln_2 Line 2 Street Address Group or individual's line 2 address 55 string
ln_2_sprs Marker of address line 2 Marker that the address as reported may be incomplete 1 Y
suppression
cty City Group or individual's city 30 string
st State Group or individual's state 2 string
zip ZIP code Group or individual's ZIP code (9 digits when available) 15 string
phn_numbr Phone Number Phone number is listed only when there is a single 20 string
phone number available for the address
Medicare Assignment
ind_assgn Clinician accepts Indicator for whether clinician accepts Medicare 1 Y/M
Medicare Assignment approved amount as payment in full
Y = Clinician accepts Medicare approved amount as
payment in full
M = Clinician may accept Medicare Assignment
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Variable Name Variable Label Description Length Values
grp_assgn Group accepts Medicare Indicator for whether group accepts Medicare approved 1 Y/M
Assignment amount as payment in full
Y = Group accepts Medicare approved amount as
payment in full
M = Group may accept Medicare Assignment
Reference
adrs_id Address ID Unique identifier for the practice location; offices within 25 string
the same building, but varied by suite or floor, will have
the same Address ID aside from the final two characters
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Doctors and Clinicians Facility Affiliations
This is the facility affiliations data publicly reported in the Provider Data Catalog.
Variable Name Variable Label Description Length Values
NPI NPI Unique clinician ID assigned by NPPES 10 string
Ind_PAC_ID PAC ID Unique individual clinician ID assigned by PECOS 10 string
lst_nm Last Name Individual clinician last name 35 string
frst_nm First Name Individual clinician first name 25 string
mid_nm Middle Name Individual clinician middle name 25 string
suff Suffix Individual clinician suffix 10 string
facility_type Facility Type Facilities can fall into the following type categories: 40 string
Hospitals
Long-term Care Hospital
Nursing Home
Inpatient Rehabilitation Facility
Home Health Agency
Hospice
Dialysis Facility
facility_afl_ccn Facility Affiliations Medicare CCN of facility type or unit within hospital where an 6 string
CCN individual clinician provides service
parent_ccn Facility Affiliations The Medicare CCN of the primary hospital where individual 6 string
Parent CCN clinician provides service, should the clinician provide services in
a unit within the hospital
Doctors and Clinicians Quality Payment Program PY 2021 Clinician Public Reporting: MIPS Measures and
Attestations
PY 2021 Merit-based Incentive Payment System (MIPS) performance information submitted by clinicians
Each line is unique at the clinician-measure (NPI-measure_cd) level. Performance information is listed in the downloadable file using
technical titles. To make information more understandable to users, Care Compare profile pages use plain language. A crosswalk
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showing both technical titles and plain language titles and descriptions can be found on the Doctors and Clinicians Initiative page.
More clinician performance information is reported in the Provider Data Catalog (PDC) than on the Care Compare profile pages (see
Additional Information).
Variable Name Variable Label Description Length Values
NPI NPI Unique clinician ID assigned by NPPES 10 string
Ind_PAC_ID PAC ID Unique individual clinician ID assigned by PECOS 10 string
lst_nm Last Name Individual clinician last name 35 string
frst_nm First Name Individual clinician first name 25 string
Name of the Alternative Payment Model (APM) in 6 string
APM_affl_1 APM Affiliation 1
which the individual eligible clinician participates
Name of the Alternative Payment Model (APM) in 6 string
APM_affl_2 APM Affiliation 2
which the individual eligible clinician participates
Name of the Alternative Payment Model (APM) in 6 string
APM_affl_3 APM Affiliation 3
which the individual eligible clinician participates
Components of measure code: 50 string
[program]_[reporting entity]_[measure
number]_[stratum] where program is defined as
MIPS, QCDR, PI, or IA; reporting entity is
measure_cd Measure Code
indicated as EC for individual eligible clinician;
measure number denotes the measure number
or string identifier; and stratum indicates
whether it is an overall rate or a single stratum
Measure or 481 string
measure_title Measure or attestation title
Attestation Title
Indicator for whether a measure is an inverse 10 Y/N
invs_msr Inverse Measure
measure
attestation_value Attestation Value Attestation value 50 Y/N
Measure 8 numeric
prf_rate Measure performance rate
Performance Rate
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Variable Name Variable Label Description Length Values
Number of patients included in the measure 8 numeric
patient_count Denominator Count
denominator
Star rating, assigned based on performance at 8 numeric
star_value Star Value the measure, stratum, collection type, and entity
type level
The established ABC™ benchmark used to assign 8 numeric
five_star_benchmark Five Star Benchmark a five-star rating for a given measure and
collection type
Collection types are defined as ATT for Web 20 string
Attestation, CLM for Claims, EHR for Electronic
Health Record, QCDR for Qualified Clinical Data
collection_type Collection Type Registry, and REG for Qualified Registry
Note: Collection type is not published for PI and
IA attestations
Indicator for whether the measure/attestation is 50 Y/N
Reported on DAC reported on Care Compare profile pages (i.e.,
CCXP_ind
profiles measures with an N value are only available in
the PDC)
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Doctors and Clinicians Quality Payment Program PY 2021 Clinician Public Reporting: Overall MIPS Performance
PY 2021 Merit-based Incentive Payment System (MIPS) Overall Clinician Performance
Each line is unique at the clinician-group (NPI-Org_PAC_ID) level. Final scores and performance category scores (Quality, Promoting
Interoperability, Improvement Activities, and Cost) are publicly reported for clinicians participating in the Merit-based Incentive
Payment System (MIPS). More information regarding scoring can be found on the Traditional MIPS Scoring Guide for the 2021
Performance Year.
Individual clinician MIPS Final Scores and performance category scores are listed in the Provider Data Catalog as required by law.
Final Scores and performance category scores are not currently reported on Care Compare profile pages.
Variable Name Variable Label Description Length Values
NPI NPI Unique clinician ID assigned by NPPES 10 string
Organization PAC Unique group ID assigned by PECOS to the 10 string
Org_PAC_ID
ID group this individual participated in
lst_nm Last Name Individual clinician last name 35 string
frst_nm First Name Individual clinician first name 25 string
Method by which the clinician achieved 20 string
scores (“individual”, “group”, “virtual group”,
source Source of scores or “apm”); if the source is “apm”, this
indicates that the MIPS APM scoring standard
was applied for this set of scores
If facility-based, the Medicare CCN of the 6 string
Facility-based facility through which the clinician’s quality
facility_ccn
scoring CCN and cost categories1 were scored under the
Hospital Value-Based Purchasing program2
1
Cost will be weighted at 0% for all MIPS Eligible Clinicians for the 2022 Performance Period in response to the COVID-19 pandemic. Further details can be
found on the QPP 2021 Cost Requirements page.
2
For PY2021, there are no clinicians who are facility-based because the Total Performance score in the Hospital-Value Based Purchasing program was not
calculated or used in scoring.
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Variable Name Variable Label Description Length Values
If facility-based, the name of the facility, as it 100 string
appears on Care Compare, through which the
Facility-based
facility_lbn clinician’s quality and cost categories1 were
scoring name
scored under the Hospital Value-Based
Purchasing program
Quality category 8 numeric
Quality_category_score Quality performance category score*
score
Promoting Interoperability (PI) performance 8 numeric
PI_category_score PI category score
category score*
Improvement Activities (IA) performance 8 numeric
IA_category_score IA category score
category score*
Cost category 3 string
Cost_category_score Cost performance category score*
score
MIPS Final Score without the Complex Patient 8 numeric
Bonus (CPB). The CPB is part of the MIPS final
MIPS Final Score
final_MIPS_score_without_CPB score based on the overall medical
without CPB
complexity and social risk for one’s patients
treated
final_MIPS_score MIPS Final Score MIPS Final Score 8 numeric
*Note: A blank value indicates that the clinician’s score for this performance category was weighted to 0 such that it did not
contribute to their MIPS Final Score.
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Doctors and Clinicians Quality Payment Program PY 2021 Group Public Reporting: MIPS Measures
PY 2021 Merit-based Incentive Payment System (MIPS) performance information submitted by groups
Each line is unique at the group-measure (org_PAC_ID-measure_cd) level. Performance information is listed in the downloadable file
using technical titles. To make information more understandable to users, Care Compare profile pages use plain language. A
crosswalk showing both technical titles and plain measure titles and descriptions can be found on the Doctors and Clinicians
Initiative page. More group performance information is reported in the PDC than on the Care Compare profile pages (see Additional
Information).
Variable Name Variable Label Description Length Values
org_nm Organization legal Name of the group, as it appears on Care 70 string
name or 'doing Compare: Doctors and Clinicians
business as' name
org_PAC_ID Group PAC ID Unique group ID assigned by PECOS to the 10 string
group
ACO_ID_1 ACO ID 1 ID used on Care Compare for the Accountable 5 string
Care Organization (ACO) with whom the group is
affiliated
ACO_nm_1 ACO Name 1 Name of the Accountable Care Organization 256 string
(ACO), as it appears on Care Compare
ACO_ID_2 ACO ID 2 ID used on Care Compare for the Accountable 5 string
Care Organization (ACO) with whom the group is
affiliated
ACO_nm_2 ACO Name 2 Name of the Accountable Care Organization 256 string
(ACO), as it appears on Care Compare
measure_cd Measure Code Components of measure code: 50 String
[program]_[reporting entity]_[measure
number]_[stratum] where program is defined as
MIPS, QCDR, PI, or IA; reporting entity is
indicated as GRP for group; measure number
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Variable Name Variable Label Description Length Values
denotes the measure number or string
identifier; and stratum indicates whether it is an
overall rate or a single stratum
measure_title Measure or Measure or attestation title 481 string
Attestation Title
invs_msr Inverse Measure Indicator for whether a measure is an inverse 10 Y/N
measure
attestation_value Attestation Value Attestation value 50 Y/N
prf_rate Measure Measure performance rate 8 numeric
Performance Rate
patient_count Denominator count Number of patients included in the measure 8 numeric
denominator
star_value Star Value Star rating, assigned based on performance at 8 numeric
the measure, stratum, collection type, and
entity type level
five_star_benchmark Five Star Benchmark The established ABC™ benchmark used to assign 8 numeric
a five-star rating for a given measure and
collection type
collection_type Collection Type Collection types are defined as ATT for Web 20 string
Attestation, CLM for claims, EHR for Electronic
Health Record, QCDR for Qualified Clinical Data
Registry, REG for Qualified Registry, and WI for
CMS Web Interface
Note: Collection type is not published for
Promoting Interoperability and Improvement
Activities attestations
CCXP_ind Reported on DAC Indicator for whether the measure is reported 50 Y/N
profiles on Care Compare profile pages (i.e., measures
with an N value are only available in the PDC)
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Doctors and Clinicians Quality Payment Program PY 2021 Group Public Reporting: Patient Experience
PY 2021 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS measures submitted by groups
Each line is unique at the group-measure (org_PAC_ID-measure_cd) level. Measures are listed in the downloadable file using
technical titles. To make measures more understandable to users, measures on Care Compare profile pages are displayed in plain
language. A crosswalk showing both technical measure titles and plain language measure titles and descriptions can be found on the
Doctors and Clinicians Initiative page. For PY 2021, CAHPS_GRP_6 is reported in the PDC only. More group performance information
is reported in the PDC than on the Care Compare profile pages (see Additional Information).
Variable Name Variable Label Description Length Values
org_nm Organization’s legal Name of the group, as it appears on Care Compare: 70 string
name or 'doing Doctors and Clinicians profile pages
business as' name
org_PAC_ID Group PAC ID Unique group ID assigned by PECOS to the group 10 string
measure_cd Measure Code Components of measure code: 50 string
[program]_[reporting entity]_[measure number] where
program is defined as CAHPS; reporting entity is indicated
as GRP for group; and measure number denotes the
CAHPS measure number
measure_title Measure Title CAHPS measure title 481 string
prf_rate Measure Measure performance rate 8 numeric
Performance Rate
patient_count Denominator count Number of patients included in the measure denominator 8 numeric
FN Footnote Footnote value 1 indicates that data are suppressed due 8 1
to insufficient sample size or low reliability
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Doctors and Clinicians Quality Payment Program PY 2021 Virtual Group Public Reporting
PY 2021 Merit-based Incentive Payment System (MIPS) performance information reported by virtual groups
Each line is unique at the virtual group-measure (virtual_group_id-measure_cd) level. Performance information is listed in the
downloadable file using technical titles. Virtual group performance information is only reported in the Provider Data Catalog (PDC)
and has no corresponding information displayed on Care Compare profile pages.
Variable Name Variable Label Description Length Values
virtual_group_id Virtual Group ID Unique ID assigned to the virtual group 15 string
Components of measure code: 50 string
[program]_[reporting entity]_[measure
number]_[stratum] where program is defined as
MIPS, PI, or IA; reporting entity is indicated as VG
measure_cd Measure Code
for virtual group; measure number denotes the
measure number or string identifier; and stratum
indicates whether it is an overall rate or a single
stratum
Measure or 481 string
measure_title Measure or attestation title
Attestation Title
Indicator for whether a measure is an inverse 10 Y/N
invs_msr Inverse Measure
measure
attestation_value Attestation Value Attestation value 50 Y/N
Measure 8 numeric
prf_rate Measure performance rate
Performance Rate
Number of patients included in the measure 8 numeric
patient_count Denominator Count
denominator
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Variable Name Variable Label Description Length Values
Collection types are defined as ATT for Web 20 string
Attestation, CLM for Claims, EHR for Electronic
Health Record, REG for Qualified Registry, and WI
for CMS Web Interface
collection_type Collection Type
Note: Collection type is not published for
Promoting Interoperability and Improvement
Activities attestations
Doctors and Clinicians 2020 Clinician Utilization Data
This is the clinician utilization data publicly reported in the Provider Data Catalog (PDC). Each line is unique at the individual-
procedure (NPI-hcpcs_code) level. CMS publicly reports utilization data for the subset of clinicians who met criteria to be included
on Care Compare and in the PDC. This is a subset of the 2020 Medicare Provider Utilization and Payment Data: Physician and Other
Supplier data, listed as Healthcare Common Procedure Coding System (HCPCS) codes. The goal in defining this subset was to identify
codes that would provide more information about the scope of care clinicians provide. This subset of publicly reported HCPCS codes
is based on the top five codes reported by each available Medicare specialty, excluding evaluation and management codes. The
evaluation and management codes do not provide descriptive information regarding care and therefore were excluded from the
available subset. To define the universe of available HCPCS codes in the PDC, the top five codes for each specialty represented on
the website were identified. However, the information available for any given clinician is not limited to their specific specialty but
rather includes the subset of codes available in the PDC across all specialties. As a result, clinicians may have data publicly reported
for more than five HCPCS codes.
A list of the 2020 HCPCS codes that are included in this file can be found on the Doctors and Clinicians Initiative page.
Variable Name Variable Label Description Length Values
NPI NPI Unique clinician ID assigned by NPPES 10 string
Ind_PAC_ID PAC ID Unique individual clinician ID assigned by PECOS 10 string
lst_nm Last Name Individual clinician last name 35 string
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Variable Name Variable Label Description Length Values
frst_nm First Name Individual clinician first name 25 string
spec Specialty Primary medical specialty reported by the individual clinician in the 35 string
selected PECOS enrollment
prac_st Practice State Individual clinician’s state of practice 2 string
hcpcs_code HCPCS code Healthcare Common Procedure Coding System (HCPCS) procedural 5 string
code billed by the individual clinician
hcpcs_description Code Description of the HCPCS code for the specific medical service furnished 258 string
Description by the individual clinician. HCPCS descriptions associated with CPT
codes are consumer friendly descriptions provided by the AMA. CPT
Consumer Friendly Descriptors are lay synonyms for CPT descriptors
that are intended to help healthcare consumers who are not medical
professionals understand clinical procedures on bills and patient
portals. CPT Consumer Friendly Descriptors should not be used for
clinical coding or documentation. All other descriptions are CMS Level II
descriptions provided in long form. Due to variable length restrictions,
the CMS Level II descriptions have been truncated to 256 bytes. As a
result, the same HCPCS description can be associated with more than
one HCPCS code. For complete CMS Level II descriptions, visit
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-
Numeric-HCPCS.html
line_srvc_cnt Service Count Count of the individual clinician's performance of the associated HCPCS 8 numeric
code within the specified calendar year
bene_cnt Beneficiary The number of eligible beneficiaries that received the service or 8 numeric
Count procedure identified by the individual clinician's HCPCS code
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Additional Information
Information in the Provider Data Catalog may not exactly match the information as displayed on Care Compare profile pages for the
following reasons:
• Clinician profiles represent all clinician-level details, while the downloadable file observations are at the
clinician/enrollment/address level. If a clinician has more than one enrollment, more than one address per enrollment,
and/or more than one group affiliation, the individual clinician will have multiple entries in the downloadable file.
o This means that a single clinician may have different specialties and different credentials from each enrollment.
• The downloadable physician demographic database focuses on clinicians and their practice locations. There is no group level
reporting in the downloadable demographic file.
o To evaluate demographic data at the group level, users can adjust this file to categorize by group affiliation.
• Clinician IDs (including the NPI, PECOS PAC ID, and PECOS enrollment ID) and group or hospital IDs (including PECOS PAC ID
and Medicare CCN) are included in the downloadable file to help distinguish clinicians and groups or hospitals with similar
names. These IDs also help identify individual clinicians who are affiliated with a group or hospital.
• The marker of line 2 suppression means that there were multiple possible addresses for that clinician in the same building. If
users need to find a mailing address for any entries with this flag, users may want to search for additional information like a
suite number.
• Only Medicare data (PECOS and claims) are used in the downloadable file. All licensed data are excluded from this
demographic dataset.
o There is no board certification information.
o There is no residency data.
• There is more performance information represented in the downloadable files in the PDC than on the Care Compare profile
pages. CMS decides which performance information to publicly report for doctors and clinicians on Care Compare based on
the published public reporting standards. To be included in the PDC, performance information must be statistically valid,
reliable, and accurate; be comparable across collection types; and meet the minimum reliability threshold, as determined by
statistical testing. To be included on Care Compare profile pages, performance information must also resonate with Medicare
patients and caregivers, as determined by user testing.
• There will be clinicians in the Overall MIPS Performance file that do not have Care Compare profile pages or the National
Downloadable File because they were assigned Final Scores and performance category scores but did not meet the
requirements to be eligible for a profile or the National Downloadable File.
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