CMS PECOS Medicare Enrollment Data
Fonteum's loaded CMS PECOS Medicare Fee-For-Service Public Provider Enrollment table had a newest source-release date of June 18, 2026 when checked July 12. Source and provenance fields vary by response; this page does not claim a completed monthly load.
Medicare enrollment by provider type
Distribution of Medicare-enrolled providers across CMS-assigned provider type categories. Internal medicine and family practice practitioners make up the plurality of the Medicare enrollment roster — the pattern matters for network adequacy analysis and specialty-specific enrollment screening.
What CMS PECOS PPEF contains
The Medicare Fee-For-Service Public Provider Enrollment file (PPEF) is CMS's monthly public extract from PECOS — the internal Provider Enrollment, Chain, and Ownership System. The PPEF contains the non-confidential fields that CMS has authorized for public release: the NPI, a CMS-assigned enrollment ID, the provider type description used for Medicare billing classification, and the enrollment state (the state where the provider's Medicare enrollment is filed).
The file does not include billing volumes, claim history, quality measures, group enrollment structures, or the full internal PECOS record. Fonteum's newest loaded source-release date was June 18, 2026 when checked July 12. NPI cross-reference and provenance fields are present only where the participating records and response supply them.
What Fonteum adds to the raw source
- NPI cross-reference — enrollment records are linked to the NPPES provider graph on NPI, enabling join queries across the full provider data graph (NPPES + PECOS + OIG LEIE + Care Compare).
- Provider type vs. NPPES taxonomy comparison— flags NPIs where the CMS enrollment type and the self-reported NPPES taxonomy diverge (e.g., enrolled as "Internal Medicine" billing under "Dermatology" taxonomy).
- Nullable source attribution where the response supplies it: source, source_url, dataset_id, snapshot, methodology, last_checked, confidence, availability, pipeline_version, DOI, license, coverage_start, coverage_end, and SLSA_url. A complete tuple is not guaranteed on every enrollment record.
- FHIR R4 Practitioner output — enrollment status surfaces as an identifier element on Practitioner resources via the /api/fhir/Practitioner endpoint with the cms-pecos-or methodology tag.
- Monthly diff feed — new enrollments, deactivations, and provider type changes between consecutive snapshots, enabling downstream systems to process only changed records.
Who uses PECOS enrollment data
Medicare enrollment confirmation is a mandatory primary-source credentialing check. Fonteum's NPI-keyed API returns enrollment status, provider type, and enrollment state with source traceability — eliminating the monthly PPEF parse from the credentialing pipeline.
CMS requires payers to maintain provider directories with Medicare enrollment status. Fonteum's enrollment layer can supply dated PECOS fields for directory workflows and flag provider-type mismatches where the participating rows support the comparison. The newest loaded PECOS source date observed on July 12, 2026 was June 18, 2026; confirm the current CMS record before acting.
The PECOS provider type distribution is the cleanest signal for specialty mix by geography at the Medicare billing level. Fonteum's enrollment layer, joined to NPPES and Care Compare, supports network adequacy modeling, specialty shortage analysis, and payer mix research across 50+ CMS provider type categories.
Frequently asked questions
- What is CMS PECOS and what does the public enrollment file contain?
- PECOS — the Provider Enrollment, Chain, and Ownership System — is CMS's database of Medicare-enrolled providers. The public extract (PPEF, Medicare Fee-For-Service Public Provider Enrollment) is a monthly release of the non-confidential subset: NPI, enrollment ID, CMS provider type description, and enrollment state. It confirms that a provider holds an active Medicare billing relationship at the time of the extract. It does not include billing volumes, quality measures, or the full internal PECOS record — those remain confidential.
- How does PECOS provider type differ from NPPES taxonomy?
- NPPES taxonomy (e.g., 'Dermatology', 'Chiropractic') is self-reported by the provider and reflects their self-designated specialty. CMS provider type (e.g., 'PRACTITIONER - DERMATOLOGY', 'CHIROPRACTIC PRACTITIONER') is assigned by CMS at enrollment and reflects the specialty under which the provider bills Medicare. The same NPI may have a different NPPES taxonomy and CMS provider type — Fonteum surfaces both and flags discrepancies as a data-quality signal in the risk layer.
- Can I use PECOS data to confirm Medicare enrollment status for a provider?
- Yes. Fonteum's PECOS layer returns a boolean enrollment flag (cms_pecos_enrollment_record) and the enrollment state for any NPI in the extract. An NPI present in the monthly PPEF release has confirmed Medicare FFS enrollment at the time of that snapshot. An NPI absent from the extract may be enrolled under a group or may not be Medicare-enrolled — Fonteum distinguishes these states explicitly in the provenance rail rather than treating absence as non-enrollment.
- How often does Fonteum refresh PECOS data?
- CMS publishes the PECOS PPEF extract monthly. Fonteum's newest production source date observed in this audit was June 18, 2026. The page shows the saved observation available to the serving table; it does not claim ingestion within 24 hours or universal prior-row retention.
- Is PECOS enrollment the same as Medicare acceptance or credentialing approval?
- No. A PECOS enrollment record indicates that the provider appears in the loaded public enrollment extract; it is not a quality endorsement, acceptance of new patients, hospital credentialing, or state licensure. Consequential status should be checked against the current CMS source.
Access the PECOS enrollment layer
The Audit Pack bundles available PECOS, NPPES, OIG LEIE, and Care Compare fields in a report artifact. A report signature, where supplied, covers the artifact rather than signing each contained fact. For API integration and custom specialty or state filters, contact the data engineering team.