PECOS NPPES Linked Data

We take all the hard work out of maintaining healthcare provider data from multiple sources. We merge various data from CMS using the NPI information. In general, PECOS is Medicare’s enrollment and revalidation system. It is the sole verified source of Medicare data.

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If you are using our healthcare CRM, you will get these data already built in and can use them for your referring provider tracking.

We take all the hard work out of maintaining healthcare provider data from multiple sources. In general, we merge various data from CMS using the NPI information. 

PECOS and the NPI registry

In general, PECOS is Medicare’s enrollment and revalidation system. It is the sole verified source of Medicare data.

We use the Physician Compare database as well. The underlying data source for the physician compare database is PECOS. There are a couple of things to understand here.

  1. PECOS is Medicare’s enrollment and revalidation system. Based on this, as you can understand, it is the primary source of information about verified Medicare professionals. I.e. professionals that can accept Medicare.
  2. However, PECOS is an enrollment system and it is not intended to provide up-to-the-minute information. 
  3. For up to date information, you would need to get information from the Physician Compare website (or the database). Physician Compare, on the other hand, uses Medicare claims data to verify the PECOS information. Physician Compare information uses claims to verify group practice affiliations and practice location. 
  4. So, while you can start with PECOS, for up to date information, you need Physician Compare information. 
  5. Please do keep in mind that if someone has NOT billed Medicare all year long, that does not mean that they cannot be in the PECOS database. 
  6. The provider would not even show up in Physician Compare if someone has registered recently (less than 6 months).
  7. Physician Compare began using Medicare claims data to verify PECOS information in mid-2013. 
  8. A provider has to have at least one practice location address in PECOS else that would NOT show up in Physician Compare. Please do keep this in mind.
  9. Please do keep in mind that if someone does not have at least one specialty in PECOS, they will NOT show up in Physician Compare. 
  10. For group practices it gets even tougher. For them to appear on Physician Compare, at least two active Medicare eligible professionals (EPs) must reassign their benefits to the group’s TIN. Unless this has been done, you will NOT get their “up to date” information on Physician Compare database.
  11. That’s why we recommend using BOTH these data sources.

Whose information can you find on PECOS?

  • Physician (MD or DO)
  • Dental practitioner
  • Dental surgeon
  • Podiatric practitioner
  • Optometrist
  • Physician assistant (PA)
  • Certified clinical nurse specialist
  • Nurse practitioner
  • Nurse midwife
  • Clinical psychologist
  • Clinical social worker

PECOS does NOT tell you if a provider has been barred from billing Medicare or not (by the HHS/OIG).