Score Methodology & Data Sources
OV Quality Score (0–100)
The score is computed from public CMS data only, using two components: Procedure Volume (up to 50 points — the provider’s best national percentile of Medicare procedure volume) and CMS Quality (up to 50 points — the provider’s MIPS quality category score scaled from 0–100). Providers with a potential OIG exclusion-list match are scored 0 and flagged.
A dash (–) means CMS publishes no quality or volume data for the provider. That is common — most of the 8.5 million NPIs (including organizations, non-Medicare providers, and newer clinicians) have no published measures — and it is not a negative signal.
MIPS scores currently reflect the 2023 performance year, the latest CMS has published. Procedure volumes reflect the most recent CMS release.
Important caveats
This tool is informational and is not medical advice, a recommendation, or an endorsement of any provider. Exclusion flags are potential matches based on NPI only; LEIE records without an NPI are not matched. Verify any match at exclusions.oig.hhs.gov before acting on it.
Insurance participation comes from insurer-published ACA Marketplace directories and Medicare enrollment files; employer-sponsored plans are not covered, and payer directories are known to contain inaccuracies — always confirm coverage with the provider’s office.
Data sources
NPPES NPI Registry (CMS)
Full monthly replacement + weekly updates; provider identity, addresses, taxonomy, deactivations.NUCC Health Care Provider Taxonomy
Specialty classifications. © American Medical Association, used with permission of the NUCC. Updated January and July.CMS Provider Data Catalog
Clinician directory, procedure utilization, MIPS quality scores, facility affiliations, hospital ratings. Refreshed quarterly.OIG List of Excluded Individuals/Entities (LEIE)
Federal exclusion list, refreshed monthly. We match NPI-bearing records only.Healthcare.gov QHP machine-readable directories
Insurer-published Marketplace network participation, languages, and accepting-new-patients status.CMS Medicare enrollment files
Opt-out affidavits (monthly) and order-and-referring eligibility (twice weekly).CMS Open Payments
Industry payments to providers, published annually. Shown for transparency only.Data from CMS and HHS is used with attribution to the originating dataset and snapshot date. The NUCC Health Care Provider Taxonomy code set is © American Medical Association. No endorsement by CMS, HHS, the AMA, or the NUCC is implied.