U.S. Department of Health & Human Services

Medicare Fee-For-Service Public Provider Enrollment

Name: Medicare Fee-For-Service Public Provider Enrollment
Creator: U.S. Department of Health & Human Services

Public Medicare Fee-For-Service provider enrollment records track those actively approved to bill Medicare or who have completed the 855O application, as sourced from the Provider Enrollment, Chain, and Ownership System (PECOS). Each record typically covers the provider's National Provider Identifier (NPI), enrollment status and effective dates, specialty, and practice location details.

Example records

Namelegal entity	Stateaddress	Npiregistration	Pecos Asct Cntl IDidentifier	Enrlmt IDidentifier	Provider Type Cdindustry	Provider Type Descriptionindustry
MINDCARE OF AMERICA LLC	FL	1538907100	8426598699	O20240913003793	12-70	PART B SUPPLIER - CLINIC/GROUP PRACTICE
EMPATHIC EMPOWERMENT COUNSELING PLLC	PA	1265214415	4385080977	O20240913003792	12-70	PART B SUPPLIER - CLINIC/GROUP PRACTICE
RY HEALTH PLLC	MI	1346073954	1456891621	O20240913003681	12-70	PART B SUPPLIER - CLINIC/GROUP PRACTICE

Use cases

Medicare Billing Eligibility Check During Vendor Onboarding

A healthcare staffing firm or medical billing company onboarding a new provider group verifies that the entity holds an active Medicare enrollment and is approved to bill as the correct supplier type before executing a contract.

NameNpiEnrlmt IDProvider Type DescriptionState

Fraud Pattern Detection Across Enrollment Records

A fraud analytics team at a health insurance or payment integrity firm flags provider entities that share a PECOS controlling ID across multiple enrollment records in different states, which may indicate a shell network billing under separate identities.

Pecos Asct Cntl IDEnrlmt IDNpiNameState

Market Sizing for Healthcare Sales Territories

A medical device or healthcare SaaS company segments the enrolled provider population by supplier type and state to estimate the addressable market for a product targeting specific Medicare-approved practice categories.

Provider Type DescriptionProvider Type CdStateName