# CMS Medicare PECOS Provider Enrollment Scraper (`jungle_synthesizer/cms-medicare-pecos-enrollment-crawler`) Actor CMS Medicare provider enrollment: PECOS active enrollments, Opt-Out Affidavits, and Order/Refer authority. Filter by NPI, state, or specialty. Merged-by-NPI mode joins all three datasets. For pharma, medical-device, billing/RCM, and payer credentialing. Pairs with NPPES NPI crawler. - **URL**: https://apify.com/jungle\_synthesizer/cms-medicare-pecos-enrollment-crawler.md - **Developed by:** [BowTiedRaccoon](https://apify.com/jungle_synthesizer) (community) - **Categories:** Business, Other, Developer tools - **Stats:** 2 total users, 1 monthly users, 100.0% runs succeeded, NaN bookmarks - **User rating**: No ratings yet ## Pricing Pay per event This Actor is paid per event. You are not charged for the Apify platform usage, but only a fixed price for specific events. Learn more: https://docs.apify.com/platform/actors/running/actors-in-store#pay-per-event ## What's an Apify Actor? Actors are a software tools running on the Apify platform, for all kinds of web data extraction and automation use cases. In Batch mode, an Actor accepts a well-defined JSON input, performs an action which can take anything from a few seconds to a few hours, and optionally produces a well-defined JSON output, datasets with results, or files in key-value store. In Standby mode, an Actor provides a web server which can be used as a website, API, or an MCP server. Actors are written with capital "A". ## How to integrate an Actor? If asked about integration, you help developers integrate Actors into their projects. You adapt to their stack and deliver integrations that are safe, well-documented, and production-ready. The best way to integrate Actors is as follows. In JavaScript/TypeScript projects, use official [JavaScript/TypeScript client](https://docs.apify.com/api/client/js.md): ```bash npm install apify-client ``` In Python projects, use official [Python client library](https://docs.apify.com/api/client/python.md): ```bash pip install apify-client ``` In shell scripts, use [Apify CLI](https://docs.apify.com/cli/docs.md): ````bash # MacOS / Linux curl -fsSL https://apify.com/install-cli.sh | bash # Windows irm https://apify.com/install-cli.ps1 | iex ```bash In AI frameworks, you might use the [Apify MCP server](https://docs.apify.com/platform/integrations/mcp.md). If your project is in a different language, use the [REST API](https://docs.apify.com/api/v2.md). For usage examples, see the [API](#api) section below. For more details, see Apify documentation as [Markdown index](https://docs.apify.com/llms.txt) and [Markdown full-text](https://docs.apify.com/llms-full.txt). # README ## CMS Medicare PECOS Provider Enrollment Crawler Extracts Medicare provider enrollment data from three [CMS open-data](https://data.cms.gov) APIs: the PECOS/DAC national file (~2.86M active enrollments), the Opt-Out Affidavits list (~56K providers who left Medicare), and the Order and Referring Authority list (~2M NPIs). Returns clean JSON with 19 normalized fields per record, filterable by NPI, state, or specialty. --- ### CMS Medicare PECOS Enrollment Crawler Features - Pulls from three CMS datasets in a single run — PECOS enrollment, opt-out status, and order/refer authority - Merges all three by NPI in `all` mode, so one output row carries fields from every source - Filters by NPI (exact 10-digit lookup), US state code, or specialty string - Returns 19 standardized fields including enrollment ID, PAC ID, telehealth status, and opt-out dates - Pure API — no browser, no proxy, no CAPTCHA. CMS publishes these as open government data - Streaming pagination across all three APIs; handles the full 2.86M-row DAC file without memory issues - 200ms courtesy delay between requests — stays polite to a public API --- ### What Can You Do With CMS PECOS Data? - **Pharma and medical device reps** — Build territory lists of active Medicare-enrolled providers by specialty and state, filtered to the NPIs that can order your products - **Billing and RCM teams** — Verify enrollment status and Order/Refer authority before submitting claims; catch opted-out providers before they become denials - **Payer credentialing departments** — Cross-reference PECOS enrollment IDs and PAC IDs against your panel data to catch gaps and discrepancies - **Healthcare data vendors** — Enrich NPPES NPI directory exports with Medicare-specific enrollment status, opt-out flags, and order-and-refer eligibility - **Compliance and audit teams** — Flag providers in your network who have opted out of Medicare, and verify which categories of order-and-refer authority they hold --- ### How CMS Medicare PECOS Enrollment Crawler Works 1. Select a dataset mode: `all` (merged), `pecos` (enrollment only), `opt_out`, or `order_refer`. The default is `all`. 2. Optionally supply an NPI, state code, or specialty to filter. Leave all three blank for a full-dataset pull. 3. The crawler pages through the selected CMS API(s), normalizing field names across the three different response shapes. 4. In `all` mode, records stream from the PECOS/DAC file enriched with opt-out and order-and-refer lookups per NPI. In single-dataset modes, the `json_api` crawler handles pagination directly. --- ### Input ```json { "dataset": "all", "npi": "", "state": "CA", "specialty": "", "maxItems": 100, "sp_intended_usage": "Building a provider list for credentialing", "sp_improvement_suggestions": "n/a" } ```` | Field | Type | Default | Description | |-------|------|---------|-------------| | `dataset` | string | `"all"` | Which dataset to pull. `all` merges all three by NPI; `pecos` streams the DAC enrollment file; `opt_out` returns only opted-out providers; `order_refer` returns order-and-refer authority records | | `npi` | string | `""` | Single 10-digit NPI for a targeted lookup. Leave blank for full dataset | | `state` | string | `""` | Two-letter US state code (e.g., `CA`, `TX`). Filters PECOS and opt-out datasets | | `specialty` | string | `""` | Specialty name or taxonomy prefix to filter PECOS records (e.g., `INTERNAL MEDICINE`) | | `maxItems` | integer | `10` | Maximum rows to return. Set to `0` for an unlimited full-dataset pull | | `proxyConfiguration` | object | `{useApifyProxy: false}` | Proxy settings. Not needed — CMS APIs are public | | `sp_intended_usage` | string | required | Brief description of how you'll use the data | | `sp_improvement_suggestions` | string | required | Feedback or "n/a" | **Single-NPI lookup:** ```json { "dataset": "all", "npi": "1245084383", "maxItems": 0, "sp_intended_usage": "Provider credentialing check", "sp_improvement_suggestions": "n/a" } ``` **Full opt-out list:** ```json { "dataset": "opt_out", "maxItems": 0, "sp_intended_usage": "Building Medicare opt-out exclusion list", "sp_improvement_suggestions": "n/a" } ``` *** ### CMS Medicare PECOS Enrollment Crawler Output Fields #### All Mode (Merged) Streams PECOS/DAC records enriched with opt-out and order-and-refer data for NPI-filtered queries. For state or specialty filters, returns PECOS enrollment fields with opt-out and order-and-refer fields set to their defaults. ```json { "npi": "1245084383", "first_name": "JOHN", "last_name": "SMITH", "organization_name": "", "specialty": "INTERNAL MEDICINE", "taxonomy_code": "", "enrollment_id": "I20031105000066", "pac_id": "2860530703", "gender": "M", "credential": "MD", "enrollment_state": "CA", "address": "123 MAIN ST", "city": "LOS ANGELES", "zip_code": "90001", "phone": "3105550100", "telehealth": "Y", "group_assignment": "I", "reassignments_count": 2, "opt_out_status": "not_opted_out", "opt_out_effective_date": "", "opt_out_end_date": "", "order_refer_authority": ["PARTB", "DME"], "order_refer_eligible": true, "source_dataset": "PECOS,OrderRefer" } ``` | Field | Type | Description | |-------|------|-------------| | `npi` | string | 10-digit National Provider Identifier | | `first_name` | string | Provider first name | | `last_name` | string | Provider last name | | `organization_name` | string | Organization or facility name (for group/org NPIs) | | `specialty` | string | Primary specialty description | | `taxonomy_code` | string | Primary taxonomy code (populated by NPPES join; blank in raw CMS data) | | `enrollment_id` | string | CMS enrollment ID from PECOS/DAC dataset | | `pac_id` | string | Provider and Affiliate Control (PAC) ID | | `gender` | string | Provider gender: `M` or `F` | | `credential` | string | Credential: MD, DO, NP, PA, etc. | | `enrollment_state` | string | State of Medicare enrollment | | `address` | string | Practice street address | | `city` | string | Practice city | | `zip_code` | string | Practice ZIP code | | `phone` | string | Practice phone number | | `telehealth` | string | Telehealth indicator: `Y` or `N` | | `group_assignment` | string | Individual or group Medicare assignment: `I` or `M` | | `reassignments_count` | number | Organization member count (from PECOS reassignment data) | | `opt_out_status` | string | `opted_out` or `not_opted_out` | | `opt_out_effective_date` | string | Date the provider opted out of Medicare | | `opt_out_end_date` | string | Date the opt-out period expires | | `order_refer_authority` | array | Categories of order-and-refer authority: `PARTB`, `DME`, `HHA`, `PMD`, `HOSPICE` | | `order_refer_eligible` | boolean | True if the provider has any order-and-refer authority | | `source_dataset` | string | Which datasets contributed data: `PECOS`, `OptOut`, `OrderRefer`, or combinations like `PECOS,OrderRefer` | #### Opt-Out Mode ```json { "npi": "1234567890", "first_name": "JANE", "last_name": "DOE", "specialty": "PSYCHIATRY", "enrollment_state": "NY", "address": "456 ELM ST", "city": "NEW YORK", "zip_code": "10001", "opt_out_status": "opted_out", "opt_out_effective_date": "07/01/2022", "opt_out_end_date": "07/01/2024", "source_dataset": "OptOut" } ``` #### Order-Refer Mode ```json { "npi": "9876543210", "first_name": "ROBERT", "last_name": "JONES", "order_refer_authority": ["PARTB", "HHA", "HOSPICE"], "order_refer_eligible": true, "source_dataset": "OrderRefer" } ``` *** ### 🔍 FAQ #### How do I scrape CMS Medicare PECOS enrollment data? CMS Medicare PECOS Enrollment Crawler connects to the CMS open-data APIs directly — no authentication or API key required. Configure your dataset mode and filters, set `maxItems` to `0` for a full pull, and run. The actor handles pagination, normalization, and field merging automatically. #### How much does this actor cost to run? CMS Medicare PECOS Enrollment Crawler uses pay-per-event pricing at $0.001 per record. A full PECOS pull (~2.86M records) costs roughly $2.86. Filtered runs by state or NPI cost proportionally less. There is also a $0.10 platform fee per run start. #### What data is available from the CMS PECOS API? CMS Medicare PECOS Enrollment Crawler returns enrollment status, specialty, practice address, telehealth flag, group assignment, opt-out status and dates, and order-and-refer authority across five categories (PARTB, DME, HHA, PMD, HOSPICE). It does not return billing volume, claim counts, or financial data — those are in separate CMS datasets. #### Does this actor need proxies? CMS Medicare PECOS Enrollment Crawler does not need proxies. These are public government APIs with no IP-based rate limiting. Set `proxyConfiguration: { useApifyProxy: false }` and the actor runs without any proxy overhead. #### Can I filter by specialty or taxonomy code? Filter by specialty string using the `specialty` input field. The CMS PECOS API matches against the primary specialty description (e.g., `INTERNAL MEDICINE`). Taxonomy code filtering is not directly supported by the CMS API — filter by specialty description instead, then join to the NPPES NPI dataset by NPI if you need taxonomy codes. *** ### Need More Features? Need custom filters, additional CMS datasets, or a data join with NPPES? [File an issue](https://console.apify.com/actors/issues) or get in touch. ### Why Use CMS Medicare PECOS Enrollment Crawler? - **Three datasets, one run** — PECOS enrollment, opt-out status, and order-and-refer authority merged by NPI, so you don't have to cross-reference three CSV files yourself - **Affordable** — $0.001 per record, no proxy costs, and the entire 2.86M-row DAC file costs under $3 - **Government source** — Data comes directly from CMS open-data APIs, updated monthly (PECOS/opt-out) or weekly (order-and-refer), with no intermediary or third-party aggregator markup # Actor input Schema ## `sp_intended_usage` (type: `string`): Please describe how you plan to use the data extracted by this crawler. ## `sp_improvement_suggestions` (type: `string`): Provide any feedback or suggestions for improvements. ## `sp_contact` (type: `string`): Provide your email address so we can get in touch with you. ## `dataset` (type: `string`): Which provider dataset to pull. 'all' merges all three datasets by NPI. ## `npi` (type: `string`): Single 10-digit NPI to look up. Leave blank for full dataset. ## `state` (type: `string`): Two-letter US state code to filter by (e.g. CA, TX). Leave blank for all states. ## `specialty` (type: `string`): Specialty name or taxonomy code prefix to filter by. Leave blank for all specialties. ## `maxItems` (type: `integer`): Maximum rows to return per dataset. 0 = unlimited (full dataset pull). ## `proxyConfiguration` (type: `object`): Proxy settings. CMS open data APIs do not require proxies. ## Actor input object example ```json { "sp_intended_usage": "Describe your intended use...", "sp_improvement_suggestions": "Share your suggestions here...", "sp_contact": "Share your email here...", "dataset": "all", "maxItems": 10, "proxyConfiguration": { "useApifyProxy": false } } ``` # Actor output Schema ## `results` (type: `string`): No description # API You can run this Actor programmatically using our API. Below are code examples in JavaScript, Python, and CLI, as well as the OpenAPI specification and MCP server setup. ## JavaScript example ```javascript import { ApifyClient } from 'apify-client'; // Initialize the ApifyClient with your Apify API token // Replace the '' with your token const client = new ApifyClient({ token: '', }); // Prepare Actor input const input = { "sp_intended_usage": "Describe your intended use...", "sp_improvement_suggestions": "Share your suggestions here...", "sp_contact": "Share your email here...", "dataset": "all", "npi": "", "state": "", "specialty": "", "maxItems": 10, "proxyConfiguration": { "useApifyProxy": false } }; // Run the Actor and wait for it to finish const run = await client.actor("jungle_synthesizer/cms-medicare-pecos-enrollment-crawler").call(input); // Fetch and print Actor results from the run's dataset (if any) console.log('Results from dataset'); console.log(`💾 Check your data here: https://console.apify.com/storage/datasets/${run.defaultDatasetId}`); const { items } = await client.dataset(run.defaultDatasetId).listItems(); items.forEach((item) => { console.dir(item); }); // 📚 Want to learn more 📖? Go to → https://docs.apify.com/api/client/js/docs ``` ## Python example ```python from apify_client import ApifyClient # Initialize the ApifyClient with your Apify API token # Replace '' with your token. client = ApifyClient("") # Prepare the Actor input run_input = { "sp_intended_usage": "Describe your intended use...", "sp_improvement_suggestions": "Share your suggestions here...", "sp_contact": "Share your email here...", "dataset": "all", "npi": "", "state": "", "specialty": "", "maxItems": 10, "proxyConfiguration": { "useApifyProxy": False }, } # Run the Actor and wait for it to finish run = client.actor("jungle_synthesizer/cms-medicare-pecos-enrollment-crawler").call(run_input=run_input) # Fetch and print Actor results from the run's dataset (if there are any) print("💾 Check your data here: https://console.apify.com/storage/datasets/" + run["defaultDatasetId"]) for item in client.dataset(run["defaultDatasetId"]).iterate_items(): print(item) # 📚 Want to learn more 📖? Go to → https://docs.apify.com/api/client/python/docs/quick-start ``` ## CLI example ```bash echo '{ "sp_intended_usage": "Describe your intended use...", "sp_improvement_suggestions": "Share your suggestions here...", "sp_contact": "Share your email here...", "dataset": "all", "npi": "", "state": "", "specialty": "", "maxItems": 10, "proxyConfiguration": { "useApifyProxy": false } }' | apify call jungle_synthesizer/cms-medicare-pecos-enrollment-crawler --silent --output-dataset ``` ## MCP server setup ```json { "mcpServers": { "apify": { "command": "npx", "args": [ "mcp-remote", "https://mcp.apify.com/?tools=jungle_synthesizer/cms-medicare-pecos-enrollment-crawler", "--header", "Authorization: Bearer " ] } } } ``` ## OpenAPI specification ```json { "openapi": "3.0.1", "info": { "title": "CMS Medicare PECOS Provider Enrollment Scraper", "description": "CMS Medicare provider enrollment: PECOS active enrollments, Opt-Out Affidavits, and Order/Refer authority. Filter by NPI, state, or specialty. Merged-by-NPI mode joins all three datasets. For pharma, medical-device, billing/RCM, and payer credentialing. Pairs with NPPES NPI crawler.", "version": "0.1", "x-build-id": "18S6P2Xs5yu3q3Ul3" }, "servers": [ { "url": "https://api.apify.com/v2" } ], "paths": { "/acts/jungle_synthesizer~cms-medicare-pecos-enrollment-crawler/run-sync-get-dataset-items": { "post": { "operationId": "run-sync-get-dataset-items-jungle_synthesizer-cms-medicare-pecos-enrollment-crawler", "x-openai-isConsequential": false, "summary": "Executes an Actor, waits for its completion, and returns Actor's dataset items in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK" } } } }, "/acts/jungle_synthesizer~cms-medicare-pecos-enrollment-crawler/runs": { "post": { "operationId": "runs-sync-jungle_synthesizer-cms-medicare-pecos-enrollment-crawler", "x-openai-isConsequential": false, "summary": "Executes an Actor and returns information about the initiated run in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK", "content": { "application/json": { "schema": { "$ref": "#/components/schemas/runsResponseSchema" } } } } } } }, "/acts/jungle_synthesizer~cms-medicare-pecos-enrollment-crawler/run-sync": { "post": { "operationId": "run-sync-jungle_synthesizer-cms-medicare-pecos-enrollment-crawler", "x-openai-isConsequential": false, "summary": "Executes an Actor, waits for completion, and returns the OUTPUT from Key-value store in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK" } } } } }, "components": { "schemas": { "inputSchema": { "type": "object", "required": [ "sp_intended_usage", "sp_improvement_suggestions" ], "properties": { "sp_intended_usage": { "title": "What is the intended usage of this data?", "minLength": 1, "type": "string", "description": "Please describe how you plan to use the data extracted by this crawler." }, "sp_improvement_suggestions": { "title": "How can we improve this crawler for you?", "minLength": 1, "type": "string", "description": "Provide any feedback or suggestions for improvements." }, "sp_contact": { "title": "Contact Email", "minLength": 1, "type": "string", "description": "Provide your email address so we can get in touch with you." }, "dataset": { "title": "CMS Dataset", "enum": [ "all", "pecos", "opt_out", "order_refer" ], "type": "string", "description": "Which provider dataset to pull. 'all' merges all three datasets by NPI." }, "npi": { "title": "NPI Filter", "type": "string", "description": "Single 10-digit NPI to look up. Leave blank for full dataset." }, "state": { "title": "State", "type": "string", "description": "Two-letter US state code to filter by (e.g. CA, TX). Leave blank for all states." }, "specialty": { "title": "Specialty / Taxonomy Filter", "type": "string", "description": "Specialty name or taxonomy code prefix to filter by. Leave blank for all specialties." }, "maxItems": { "title": "Max Items", "type": "integer", "description": "Maximum rows to return per dataset. 0 = unlimited (full dataset pull).", "default": 10 }, "proxyConfiguration": { "title": "Proxy configuration", "type": "object", "description": "Proxy settings. CMS open data APIs do not require proxies." } } }, "runsResponseSchema": { "type": "object", "properties": { "data": { "type": "object", "properties": { "id": { "type": "string" }, "actId": { "type": "string" }, "userId": { "type": "string" }, "startedAt": { "type": "string", "format": "date-time", "example": "2025-01-08T00:00:00.000Z" }, "finishedAt": { "type": "string", "format": "date-time", "example": "2025-01-08T00:00:00.000Z" }, "status": { "type": "string", "example": "READY" }, "meta": { "type": "object", "properties": { "origin": { "type": "string", "example": "API" }, "userAgent": { "type": "string" } } }, "stats": { "type": "object", "properties": { "inputBodyLen": { "type": "integer", "example": 2000 }, "rebootCount": { "type": "integer", "example": 0 }, "restartCount": { "type": "integer", "example": 0 }, "resurrectCount": { "type": "integer", "example": 0 }, "computeUnits": { "type": "integer", "example": 0 } } }, "options": { "type": "object", "properties": { "build": { "type": "string", "example": "latest" }, "timeoutSecs": { "type": "integer", "example": 300 }, "memoryMbytes": { "type": "integer", "example": 1024 }, "diskMbytes": { "type": "integer", "example": 2048 } } }, "buildId": { "type": "string" }, "defaultKeyValueStoreId": { "type": "string" }, "defaultDatasetId": { "type": "string" }, "defaultRequestQueueId": { "type": "string" }, "buildNumber": { "type": "string", "example": "1.0.0" }, "containerUrl": { "type": "string" }, "usage": { "type": "object", "properties": { "ACTOR_COMPUTE_UNITS": { "type": "integer", "example": 0 }, "DATASET_READS": { "type": "integer", "example": 0 }, "DATASET_WRITES": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_READS": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_WRITES": { "type": "integer", "example": 1 }, "KEY_VALUE_STORE_LISTS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_READS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_WRITES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_INTERNAL_GBYTES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_EXTERNAL_GBYTES": { "type": "integer", "example": 0 }, "PROXY_RESIDENTIAL_TRANSFER_GBYTES": { "type": "integer", "example": 0 }, "PROXY_SERPS": { "type": "integer", "example": 0 } } }, "usageTotalUsd": { "type": "number", "example": 0.00005 }, "usageUsd": { "type": "object", "properties": { "ACTOR_COMPUTE_UNITS": { "type": "integer", "example": 0 }, "DATASET_READS": { "type": "integer", "example": 0 }, "DATASET_WRITES": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_READS": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_WRITES": { "type": "number", "example": 0.00005 }, "KEY_VALUE_STORE_LISTS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_READS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_WRITES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_INTERNAL_GBYTES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_EXTERNAL_GBYTES": { "type": "integer", "example": 0 }, "PROXY_RESIDENTIAL_TRANSFER_GBYTES": { "type": "integer", "example": 0 }, "PROXY_SERPS": { "type": "integer", "example": 0 } } } } } } } } } } ```