medicare_info
Access Medicare data to analyze providers, hospitals, drug spending, formulary coverage, and quality metrics for healthcare research and decision-making.
Instructions
Unified tool for Medicare data operations: provider services, Part D prescribers, hospital data, spending information, hospital quality metrics, and ASP pricing. Use the method parameter to specify the operation type.
Input Schema
TableJSON Schema
| Name | Required | Description | Default |
|---|---|---|---|
| method | Yes | The operation to perform: - 'search_providers': Medicare Physician & Other Practitioners data - 'search_prescribers': Part D prescriber data - 'search_hospitals': Hospital utilization data - 'search_spending': Drug/service spending data - 'search_formulary': Part D formulary coverage - 'get_hospital_star_rating': Hospital overall quality star ratings (1-5) - 'get_readmission_rates': Hospital 30-day readmission rates by condition - 'get_hospital_infections': Hospital-acquired infections (HAI) data - 'get_mortality_rates': Hospital 30-day mortality rates - 'search_hospitals_by_quality': Find hospitals by quality metrics - 'compare_hospitals': Compare quality metrics across hospitals - 'get_vbp_scores': Hospital Value-Based Purchasing performance scores - 'get_hcahps_scores': Patient experience (HCAHPS) survey scores - 'get_asp_pricing': Medicare Part B ASP pricing data - 'get_asp_trend': ASP pricing trends over time - 'compare_asp_pricing': Compare ASP across drugs - 'get_formulary_trend': Track formulary changes over time (prior auth, tiers, coverage) | |
| dataset_type | No | For search_providers: Type of dataset to search. Options: - 'geography_and_service': Use when you need to compare regions, analyze geographic patterns, study regional variations in healthcare delivery, understand geographic distribution of healthcare services, or calculate per-capita/per-beneficiary rates by region. - 'provider_and_service': Use when you need to analyze individual provider performance, track specific procedures by provider, calculate total procedures across providers, or study provider-level service patterns and outcomes. - 'provider': Use when you need to analyze provider demographics, study provider participation in Medicare, understand provider practice patterns, or examine provider-level beneficiary characteristics and risk scores. | |
| year | No | For search_providers: Year of the dataset to query (2013 to latest available year, defaults to latest year). | |
| hcpcs_code | No | For search_providers: HCPCS code to search for (e.g., '99213' for established patient office visit). | |
| provider_type | No | For search_providers: Type of provider to search for (e.g., 'Cardiology', 'Podiatry', 'Family Practice'). | |
| geo_level | No | For search_providers: Geographic level for filtering (e.g., 'National', 'State', 'County', 'ZIP'). | |
| geo_code | No | For search_providers: Geographic code to filter by (e.g., 'CA' for California, '06037' for Los Angeles County). | |
| place_of_service | No | For search_providers: Place of service code to filter by (e.g., 'F' for facility, 'O' for office, 'H' for hospital). | |
| size | No | Number of results to return (default: 10 for search_providers, 25 for search_formulary, max: 5000). | |
| offset | No | Starting result number for pagination (default: 0). | |
| sort_by | No | For search_providers: Field to sort results by (e.g., 'Tot_Srvcs', 'Tot_Benes', 'Tot_Mdcr_Pymt_Amt'). | |
| sort_order | No | For search_providers: Sort order ('asc' or 'desc', default: 'desc'). | |
| drug_name | No | For search_prescribers: Drug name to search for - brand or generic (e.g., 'semaglutide', 'Ozempic', 'metformin'). Searches both brand and generic names. | |
| prescriber_type | No | For search_prescribers: Prescriber specialty (e.g., 'Endocrinology', 'Family Practice', 'Internal Medicine'). | |
| prescriber_npi | No | For search_prescribers: National Provider Identifier (NPI) of the prescriber. | |
| state | No | For search_prescribers, search_hospitals: State abbreviation (e.g., 'CA', 'TX', 'NY'). | |
| hospital_name | No | For search_hospitals: Hospital name (partial match supported). | |
| hospital_id | No | For search_hospitals: CMS Certification Number (CCN) or provider ID. | |
| drg_code | No | For search_hospitals (inpatient): Diagnosis Related Group (DRG) code. | |
| spending_drug_name | No | For search_spending: Drug name for spending analysis (brand or generic). | |
| spending_type | No | For search_spending: Type of spending data - 'part_d' (prescription drugs), 'part_b' (administered drugs). Default: 'part_d'. | |
| formulary_drug_name | No | For search_formulary: Drug name to search for (partial match supported, e.g., 'metformin', 'insulin'). At least one of formulary_drug_name or ndc_code is required. | |
| ndc_code | No | For search_formulary: NDC (National Drug Code) for exact drug identification (e.g., '00002143380'). At least one of drug_name or ndc_code is required. | |
| tier | No | For search_formulary: Tier number to filter by (1=Preferred Generic, 2=Generic, 3=Preferred Brand, 4=Non-Preferred Brand, 5=Specialty, 6=Select Care). | |
| requires_prior_auth | No | For search_formulary: Filter by prior authorization requirement (true=requires PA, false=no PA required). | |
| has_quantity_limit | No | For search_formulary: Filter by quantity limit (true=has limit, false=no limit). | |
| has_step_therapy | No | For search_formulary: Filter by step therapy requirement (true=requires ST, false=no ST required). | |
| plan_state | No | For search_formulary: State abbreviation to filter plans (e.g., 'CA', 'TX', 'NY'). | |
| plan_id | No | For search_formulary: Medicare Part D plan ID to filter by specific plan. | |
| quality_hospital_id | No | For hospital quality methods: CMS Certification Number (CCN) to lookup specific hospital (e.g., '050146'). | |
| quality_state | No | For hospital quality methods: State abbreviation to filter hospitals (e.g., 'CA', 'TX', 'NY'). | |
| min_star_rating | No | For search_hospitals_by_quality: Minimum star rating (1-5) to filter hospitals. | |
| condition | No | For get_readmission_rates/get_mortality_rates: Medical condition to filter by (e.g., 'heart_failure', 'pneumonia', 'heart_attack', 'copd', 'stroke'). | |
| infection_type | No | For get_hospital_infections: Type of infection (e.g., 'CLABSI', 'CAUTI', 'SSI', 'CDIFF', 'MRSA'). | |
| metrics | No | For compare_hospitals: Array of metrics to compare (e.g., ['star_rating', 'readmission_rate', 'mortality_rate', 'infection_rate']). | |
| hospital_ids | No | For compare_hospitals: Array of hospital CCN IDs to compare. | |
| hcpcs_code_asp | No | For ASP pricing methods: HCPCS code for Part B drug (e.g., 'J9035' for Bevacizumab). | |
| quarter | No | For get_asp_pricing: Quarter for ASP data (e.g., '2025Q1', '2024Q4'). | |
| start_quarter | No | For get_asp_trend: Starting quarter for trend analysis (e.g., '2023Q1'). | |
| end_quarter | No | For get_asp_trend: Ending quarter for trend analysis (e.g., '2025Q1'). | |
| hcpcs_codes | No | For compare_asp_pricing: Array of HCPCS codes to compare pricing. | |
| hcahps_measure | No | For get_hcahps_scores: HCAHPS measure ID to filter by (e.g., 'H_COMP_1_A_P' for nurse communication, 'H_HSP_RATING_9_10' for hospital rating 9-10). | |
| vbp_domain | No | For get_vbp_scores: VBP domain to filter by ('clinical_outcomes', 'person_community_engagement', 'safety', 'efficiency_cost_reduction', or 'all' for total performance score). | |
| start_month | No | For get_formulary_trend: Starting month in YYYYMM format (e.g., '202401' for January 2024). | |
| end_month | No | For get_formulary_trend: Ending month in YYYYMM format (e.g., '202512' for December 2025). | |
| trend_metric | No | For get_formulary_trend: Metric to track ('prior_auth', 'tier', 'quantity_limit', 'coverage', or 'all'). Default: 'all'. |