Provider Intelligence
Identity, payer-verified practice addresses, Medicare productivity, MIPS quality, Open Payments, prescribing pattern, and 147 compliance sources joined into one dossier. Five minutes from NPI to packet.
How it works
A real provider dossier built from a real NPI. Physician name anonymized as “Dr. R.S.”; every number, address, payment, and flag is from sources our platform queried live.
Query
“Build a full dossier on this NPI. Identity, all practice addresses (use payer-verified if available), facility affiliations, Medicare productivity benchmark, MIPS, Open Payments, Part D, and compliance across every source.”
Interventional Cardiology | Texas | NPI anonymized for this demo
Solo / small group | Active since 2006 | License L4707
| Status | Active since 2006-06-12 |
| Last NPPES update | 2023-09-08 |
| Primary taxonomy | Internal Medicine, Cardiovascular Disease |
| Secondary taxonomy | Internal Medicine, Interventional Cardiology |
| License | L4707 (Texas) |
| Medicare PECOS | Part B, DME, HHA, PMD, Hospice, all eligible |
| Address | Verified by | Last verified |
|---|---|---|
| 450 Blossom St, Ste D, Webster, TX 77598 | Anthem, Humana | 2026-02-22 |
| 1240 Clear Lake City Blvd, Houston, TX 77062 | Anthem | 2026-01-13 |
| 1213 Hermann Dr, Ste 340, Houston, TX 77004 | BCBS-MI, Anthem | 2026-03-31 |
| Facility | City | Source |
|---|---|---|
| CPF Cardiology Associates, P.A. | Webster, TX | Care Compare + Humana FHIR |
| Bay Area Heart PLLC | Webster, TX | Care Compare |
| Metric | Value | Peer position |
|---|---|---|
| Medicare payment (2023) | $1.998M | P95 |
| Total beneficiaries | 1,511 | - |
| Total services | 15,782 | - |
| Unique HCPCS codes | 123 | - |
| Estimated wRVUs | 18,688 | Top decile |
| Avg patient risk score | 1.66 | Sicker mix |
| Code | Description | Services | Revenue |
|---|---|---|---|
| 78431 | Nuclear medicine cardiac PET with concurrent CT | 342 | $653,941 |
| A9555 | Rubidium Rb-82 diagnostic, per study dose | 346 | $211,504 |
| 99214 | Established patient office visit, 30-39 min | 2,017 | $186,767 |
| 99490 | Chronic care management, first 20 min | 3,104 | $152,459 |
| 93306 | Echocardiogram with color Doppler | 916 | $126,968 |
Follow-up query
“Now show MIPS quality, Open Payments by manufacturer, and the top Part D drugs by claim volume and total cost. Flag anything unusual.”
Three layers no enterprise provider database joins in one query
| Year | Final score | Payment adj. | Quality | PI | Verdict |
|---|---|---|---|---|---|
| 2023 | 25.94 | -5.89% | 25.0 | 0.00 | Penalty |
| 2022 | 26.8 | -5.78% | 40.0 | 0.00 | Penalty |
| Manufacturer | Nature | Total | Payments | Years |
|---|---|---|---|---|
| Janssen Pharmaceuticals | Speaker / faculty fees | $74,755 | 26 | 2016-2019 |
| Boehringer Ingelheim | Speaker / faculty fees | $71,775 | 32 | 2016-2021 |
| Sanofi-Aventis | Speaker / faculty fees | $49,998 | 25 | 2016-2019 |
| Esperion Therapeutics | Speaker / faculty fees | $47,450 | 18 | 2021-2024 |
| AstraZeneca | Speaker / faculty fees | $15,050 | 13 | 2019-2021 |
| St. Jude Medical | Speaker / faculty fees | $12,758 | 13 | 2016 |
| Drug | Claims | Total cost | Beneficiaries |
|---|---|---|---|
| Metoprolol Succinate | 1,150 | $22,058 | 346 |
| Clopidogrel | 1,100 | $20,751 | 345 |
| Rosuvastatin | 1,020 | $20,606 | 308 |
| Atorvastatin | 960 | $13,469 | 289 |
| Eliquis (apixaban) | 777 | $766,279 | 169 |
| Amlodipine | 670 | $5,557 | 207 |
| Xarelto (rivaroxaban) | 413 | $464,976 | 95 |
Follow-up query
“Compliance screen across every source. Any sanctions, exclusions, state board discipline, litigation. Separate enforcement-grade flags from disclosure-grade.”
Composite risk grade: D | Cross-state alert active
| Source | Finding | Severity |
|---|---|---|
| VA Board of Medicine | Discipline record on file, license currently active | Hard flag |
| Cross-state alert | TX-licensed and active; VA discipline record. Cross-check recommended. | Hard flag |
| Federal court (FCA) | Named-party match: WALIA v. MICHAEL (D.D.C. 1:18-cv-00510, 2018). Common name; verification required. | Needs verify |
| Open Payments | $323K+ lifetime pharma payments across 20 manufacturers; mostly speaker fees | Disclosure flag |
| OIG LEIE, SAM.gov, FDA debarment, Medicare opt-out | Clean | Clear |
| NPI deactivation | Active | Clear |
What you can ask
Each prompt runs against real data. Follow-ups carry context across the conversation.
Pre-hire dossier (hospital recruiting)
“We are extending an offer to [Dr. Name, NPI]. Build the full dossier. Identity, all licenses across states, MIPS, Medicare billing pattern, Open Payments, any state board discipline, any federal court mentions.”
The complete pre-offer packet. Catches cross-state board discipline, MIPS penalties, and disclosure-grade industry ties before the offer letter goes out.
“Run the same dossier on the two physicians they listed as references. Flag any discrepancies in claimed specialty or affiliation.”
Reference validation against NPI registry + state board data.
“Compare their Medicare billing pattern to peer cardiologists in our metro. Is their volume consistent with the call schedule we are offering?”
Productivity benchmark grounds the comp negotiation.
Without Medistill
NPPES + state board portal + Open Payments portal + QPP portal + PACER, one at a time. 2-4 hours per candidate.
Pre-contract diligence (payer / ACO / MSO)
“We are about to add [Dr. Name, NPI] to our value-based network. Run the full risk profile. Flag MIPS penalties, cross-state discipline, FCA exposure, and Open Payments above $25K from any single manufacturer.”
Contracting wants to know what hits the network's quality bonus pool and what creates anti-kickback exposure.
“Pull their Part D prescribing pattern. Are they an outlier on branded vs generic for the conditions our population manages?”
Prescribing pattern shapes the medical loss ratio.
Without Medistill
Quality team checks MIPS, compliance team checks LEIE+SAM, contracting checks Open Payments. Nobody synthesizes.
PE corp dev diligence on key physicians
“We are evaluating an acquisition of [Practice Name]. Pull the top 5 physicians by Medicare billing. For each, build the dossier and flag anything that could derail the deal.”
In physician-practice deals, 60-80% of the asset is the top 3-5 doctors. Diligence on them is as important as diligence on the entity.
“Of those 5, which are within 5 years of typical retirement age based on enumeration date? Flag the succession risk.”
Retention risk modeling against NPI enumeration history.
“Run the same screen on their pre-acquisition referral network. Who are their top 10 referral partners and what is the geographic concentration?”
Referral concentration drives revenue durability.
Without Medistill
Definitive Healthcare pull + manual MIPS lookups + lawyer-driven background checks. Days of work per physician.
Defense counsel pre-deposition scope
“We are preparing to depose [Dr. Name, NPI] as a defendant in a med-mal case in [State]. Pull their full dossier including federal court mentions, state board history, and prior expert witness appearances.”
Knowing the deponent's history before walking into the room.
“Pull every published article they have authored on the procedure at issue. Flag any contradictions with the defense theory.”
PubMed cross-check against the standard-of-care theory.
Without Medistill
PACER + Westlaw + state board + PubMed, four separate searches. Half a day to a full day.
Investigative / regulatory background research
“Build the full public-record dossier on [Dr. Name, NPI]. Include all payer-verified addresses (not just NPPES), every federal payment received, every state license, and any court case mentioning the name.”
Journalists, OIG investigators, and state AG offices need the complete public-record picture quickly.
“Cross-reference their Open Payments speaker fees against their Part D prescribing pattern for those manufacturers' drugs. Any signal of payment-influenced prescribing?”
Open Payments × Part D crosswalk is the standard signal for anti-kickback inquiries.
Without Medistill
FOIA requests, PACER, state board portals, NPPES. Weeks.
Batch dossier across a roster
“Here are 50 NPIs we are credentialing. For each, build the abbreviated dossier (identity, license discipline, exclusions, MIPS, Open Payments total). Flag any with risk grade C or worse.”
Combines the depth of the dossier with the breadth of credentialing. For health systems and large groups onboarding multiple providers at once.
“For the flagged providers, expand to the full dossier and produce a one-page memo per flagged finding.”
Triage-then-deep-dive workflow.
Without Medistill
Manual one-by-one screen across 4-5 tools per provider. Weeks per cohort of 50.
Why switch
Definitive Healthcare, IQVIA OneKey, Doximity, CareEvolve, NPPES, the QPP portal, Open Payments search: useful tools, none of them assembled into the dossier a recruiter, contracting analyst, or PE associate actually needs.
NPI + taxonomy
NPI + taxonomy
Single NPPES lookup
Full registry record + license history + cross-state crosswalk
Practice address freshness
Practice address freshness
NPPES self-reported, often stale
Payer-FHIR verified (Anthem, BCBS, Humana, etc.) with timestamp
Medicare productivity
Medicare productivity
Raw CMS files, no benchmark
Live billing benchmarks vs BLS wage cohort, with percentile
MIPS quality
MIPS quality
Look up on QPP portal manually
Score, payment adjustment, category breakdown surfaced
Open Payments
Open Payments
CMS portal lookup, no synthesis
Lifetime payments by manufacturer and payment nature, ranked
Part D prescribing
Part D prescribing
Raw CMS Part D files
Top drugs, cost concentration, opioid + antibiotic rate
State board discipline
State board discipline
State portals one at a time
50 states + DC checked, cross-state alerts
Federal court mentions
Federal court mentions
PACER subscription, manual search
Named-party screen across the federal court record, fuzzy matches flagged for verify
Facility affiliations
Facility affiliations
Hospital-by-hospital lookup
Care Compare + payer FHIR + claims-derived crosswalk
Output format
Output format
PDFs or static dashboards
Structured tables, conversational follow-ups
Price
Price
$100K-$500K/yr enterprise contracts
from $199/mo, full access
Data coverage
NPI registry
Payer-verified addresses
Medicare utilization
MIPS / QPP
Open Payments
Part D prescribing
State medical boards
Compliance and exclusions
Federal court mentions
Every provider, every layer, one conversation. From $199/month.