PECOS NPI Lookup — Medicare Enrollment Status

Verifying Medicare enrollment is a critical step in the credentialing and billing process for any healthcare organization that submits claims to Medicare. PECOS enrollment determines whether a provider can bill Medicare for services rendered and whether referring providers have active enrollment status — a requirement for Medicare coverage of referred services under the Affordable Care Act ordering and referring rules. This tool helps you identify any provider through NPPES and initiate the PECOS verification process.

What Is PECOS?

PECOS stands for Provider Enrollment, Chain, and Ownership System. It is the official CMS (Centers for Medicare & Medicaid Services) database for Medicare provider and supplier enrollment. Every physician, practitioner, facility, and supplier that wants to bill Medicare or be listed as a referring/ordering provider for Medicare claims must be enrolled in PECOS. PECOS enrollment is separate from having an NPI number — a provider can have an active NPI in NPPES but not be enrolled in PECOS, which would prevent them from billing Medicare or having their referrals honored.

How to Check PECOS Status by NPI Number

Step 1: Enter the provider's NPI number above to retrieve their full identity from NPPES. Step 2: Confirm the provider's name, specialty, and address. Step 3: Visit the CMS Medicare Physician Compare tool at data.cms.gov/provider-data to search for the provider by NPI and verify active Medicare enrollment. Step 4: For institutional verification, access the PECOS Web Portal at pecos.cms.hhs.gov using your Medicare credentials. CMS also publishes a bulk downloadable PECOS enrollment file quarterly that some organizations use for batch verification.

PECOS vs NPI — Critical Difference for Billing

Many billing errors and claim denials occur because providers are confused about the difference between having an NPI and being enrolled in PECOS. An NPI is assigned to virtually all healthcare providers for HIPAA transaction purposes — it is required but does not by itself authorize Medicare billing. PECOS enrollment is the actual Medicare participation authorization. Under the ACA's ordering and referring requirements, Medicare will not pay claims for services ordered or referred by providers who are not enrolled in PECOS, even if those services are rendered by enrolled providers. Both must be verified.

PECOS Enrollment Types and Provider Categories

PECOS enrollment covers several categories: individual practitioners (physicians, NPs, PAs, and other eligible providers), group practices and organizations, facilities (hospitals, SNFs, home health agencies), suppliers (DME, orthotics, prosthetics), and ordering/referring providers who do not bill directly but whose referrals trigger Medicare coverage. Each category has different enrollment requirements, application forms (855I, 855B, 855S, etc.), and review timelines. Individual practitioner enrollment typically takes 60–90 days; revalidation is required every five years.

PECOS Revalidation and Status Changes

Medicare providers must revalidate their PECOS enrollment every five years, or every three years for certain high-risk supplier types. If a provider fails to revalidate, CMS will deactivate their Medicare billing privileges — meaning claims submitted under that NPI will be denied. CMS sends revalidation notices to the address on file in PECOS; providers should ensure their PECOS contact information is current at all times. After deactivation, providers can apply for reactivation, but there may be a gap in billing privileges during processing.

Why PECOS Enrollment Matters for Referring Physicians

Since 2014, Medicare has required that all physicians and non-physician practitioners who order or refer services paid by Medicare must be enrolled in PECOS — even if they do not directly bill Medicare themselves. This includes hospital-based physicians who personally opt out of Medicare but whose referrals trigger Medicare-covered services. A hospitalist who orders lab work, imaging, or specialist consults for Medicare beneficiaries must be enrolled in PECOS or those services may not be covered. Hospitals and large group practices must track PECOS enrollment for all their medical staff, not just billing providers.

CMS Resources for PECOS Verification

CMS provides several free resources for PECOS verification. The Medicare Physician Compare database (data.cms.gov/provider-data) allows public lookup of individual provider Medicare enrollment. The PECOS Web Portal (pecos.cms.hhs.gov) provides detailed enrollment management for providers and their authorized representatives. CMS also publishes monthly PECOS enrollment files available for download through data.cms.gov, used by insurers and credentialing organizations for bulk verification. The NPPES NPI Registry (this tool) provides identity data that complements PECOS enrollment verification.

PECOS and Medicaid Enrollment

PECOS handles Medicare enrollment only. Medicaid enrollment is managed separately by each state's Medicaid program, with different applications, timelines, and requirements. Many states have begun cross-referencing their Medicaid enrollment data with PECOS to streamline provider verification, but they remain separate systems. Providers billing both Medicare and Medicaid (dual-eligible patients) must maintain active enrollment in both systems. This tool can help you identify a provider's state via NPPES, which tells you which state Medicaid program enrollment to verify.

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