| AMA credentialing products and services measured | |||||||||||
AMA Physician Profile (MD and DO) | Hospital Setting | Managed Care Setting | Ambulatory Setting | |||||||||
Credentials Element | Source | CMS | TJC* | ACHC† | DNV | CMS | NCQA | URAC | AAAHC | |||
Licensure: Current | State licensing board | ✓ | ✓ | ✓ | ✓ | (1) | (1) | ✓ | ✓ | |||
Licensure: Historical | State licensing board | + | + | ✓ | + | + | + | + | + | |||
US education | AAMC and osteopathic schools | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
ACGME-accredited training | ACGME-accredited programs | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
ABMS board certification | ABMS | + | + | ✓ | + | ✓ | ✓ | ✓ | ✓ | |||
NPI number | CMS NPPES | + | + | + | + | + | + | + | + | |||
DEA registration | DEA | + | + | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
Controlled substance registration or controlled dangerous substance information—exclusive to AMA’s VeriCre™ Physician Profile | State agencies | + | + | + | + | + | + | + | + | |||
Sanction | Licensure: Current | State licensing board | + | ✓ | ✓ | ✓ | (1) | (1) | ✓ | + § | ||
Licensure: Historical | State licensing board | + | + | ✓ | + | (1) | (1) | ✓ | + | |||
Medicare/Medicaid | OIG | + | + | ✓ | + | ✓ | ✓ | ✓ | + | |||
DEA | DEA | + | + | + | + | + | + | + | + § | |||
System for Award Management—exclusive to AMA’s VeriCre™ Physician Profile | SAM | + | + | + | + | + | + | + | + | |||
US Air Force, Army, Navy, DOD, and VA: Historical | Respective military branch/agency | + | + | + | + | + | + | + | + | |||
ECFMG identification number | ECFMG | AMA provides the number only. |
Continuous Monitoring Service of Physician Profiles | Hospital Setting | Managed Care Setting | Ambulatory Setting | |||||||
Sections Monitored on an Ongoing Basis | Update Notification Trigger | CMS | TJC* | ACHC | DNV | CMS | NCQA | URAC | AAAHC | |
Sanction | Licensure: Current and historical | Alert from state licensing board | + | + | + | + | (1) | (1) | ✓ | + |
Medicare/Medicaid | Alert from OIG | + | + | + | + | ✓ | ✓ | ✓ | + | |
DEA | Alert from DEA | + | + | + | + | + | + | + | + | |
Licensure | Changes in:
| ✓ | ✓ | ✓ | ✓ | + | + | + | + | |
NPI number | Changes in:
| + | + | + | + | + | + | + | + | |
DEA registration | Changes in:
| + | + | ✓ | + | + | + | + | + | |
ABMS board certification | Changes in:
| + | + | + | + | + | + | + | + | |
ACGME-accredited training | Changes in:
| + | + | + | + | + | + | + | + | |
US education | Changes in:
| + | + | + | + | + | + | + | + |
Information current as of Sep. 10, 2024. ©2024 American Medical Association. All rights reserved.
Symbols/indicators
✓ = meets standards
+ = exceeds standards through higher level of compliance or industry leading practice
(1) NCQA and CMS for Medicare Advantage require primary source verification of license directly with the licensing board and license sanctions directly with the licensing board or other recognized source.
Notes
* The Joint Commission accreditation standards deem the AMA Physician Professional Data™, formerly AMA Physician Masterfile, which populates AMA Physician Profiles, as a designated equivalent source for physician medical school, postgraduate medical training, and (due to its official ABMS display agent status) ABMS board certification. All other primary-source-reported information on the AMA Physician Profile meets and exceeds TJC principles for a credentials verification organization. See the AMA response to TJC CVO requirements.
† ACHC requires primary source verification of licensure from state licensing agencies but additionally requires a query of the National Practitioner Data Bank and of the Federation of State Medical Boards or the Fraud and Abuse Control Information System.
‡ Sanction Alerts: AMA provides notification only of sanctions in the profile’s “Action Notifications” section. Contact the primary source directly for sanction details.
§ The AMA Profile exceeds accreditation standards if the organization’s bylaws and/or policies and procedures do not require verification of this data element. In instances when the organization requires verification, the AMA Profile meets accreditation standards.
Acronyms
AAAHC = Accreditation Association for Ambulatory Health Care, Inc., AAMC = Association of American Medical Colleges, ABMS = American Board of Medical Specialties, ACHC = Accreditation Commission for Health Care, ACGME = Accreditation Council for Graduate Medical Education, AMA = American Medical Association, CMS for hospital setting = Centers for Medicare & Medicaid Services: Conditions of Participation for Hospitals, CMS for managed care setting = Centers for Medicare & Medicaid Services: Medicare Advantage, DEA = Drug Enforcement Administration, DNV = DNV Healthcare, DOD = Department of Defense, ECFMG = Educational Commission for Foreign Medical Graduates, HFAP = Healthcare Facilities Accreditation Program, NCQA = National Committee for Quality Assurance, NPPES = National Plan and Provider Enumeration System, OIG = Office of Inspector General, SAM = System for Award Management , TJC = The Joint Commission, VA = Veterans Administration
Disclaimer
This publication is for informational purposes only. The AMA has consulted authors and editors believed to be knowledgeable in their fields to produce this publication. However, the AMA encourages readers to consult their own professional advisors or the accrediting bodies. The AMA disclaims all warranties and liability for this content.