CMS PECOS Medicare Provider Enrollment Scraper API

Screen official CMS public Medicare provider-enrollment evidence populated from the Provider Enrollment, Chain, and Ownership System (PECOS). Search by exact NPI, provider or organization keyword, legal name, enrollment state, or CMS provider type.

Exact-NPI screening merges five official CMS evidence surfaces:

• active Medicare Fee-for-Service public provider enrollment
• PECOS Associate Control/PAC IDs and enrollment IDs
• ordering/referring authority for Part B, DME, home health, PMD, and hospice
• provider opt-out affidavits and current effective periods
• revalidation records, specialties, due dates, and reassignment counts
• published revocations, reasons, effective dates, and re-enrollment-bar expiration dates

Built for payer and provider credentialing, revenue-cycle and claims QA, healthcare compliance, network management, provider onboarding, sales research, Medicare enrollment verification, and public-record enrichment.

Fast first run

Click Start with the default input:

{
  "npi": "1003879883",
  "includeStatusChecks": true,
  "maxResults": 25
}

The deterministic example returns an active Medicare enrollment for Antonio Alvarez Rodriguez, its PAC/enrollment IDs, ordering/referring flags, and linked revalidation evidence.

High-value searches

Exact NPI screening

{
  "npi": "1003000126",
  "includeStatusChecks": true
}

An exact NPI takes precedence over other filters and always checks all five datasets. Multiple active enrollment rows are aggregated into one provider result with nested enrollments.

Organization search

Clear the default npi, then use a keyword:

{
  "npi": "",
  "query": "MAYO CLINIC",
  "state": "MN",
  "includeStatusChecks": true,
  "maxResults": 25
}

query performs CMS full-text matching. organizationName, firstName, lastName, and providerType are exact filters.

Opt-out evidence by NPI

{
  "npi": "1720444581"
}

If an NPI is absent from the active-enrollment extract but appears in a supplemental source, the actor returns CMS_PECOS_STATUS_ONLY_FOUND rather than an ambiguous no-match.

Revocation and re-enrollment-bar evidence

{
  "npi": "1801839063"
}

Published revocation evidence includes every matched enrollment, CMS's stated authority/reason, effective date, re-enrollment-bar expiration date, and a retrieval-date currentReenrollmentBar calculation.

Output

Each NPI result can include:

• active-enrollment indicator and count
• provider and organization names
• enrollment states and CMS provider types
• PECOS Associate Control/PAC IDs and enrollment IDs
• every underlying active enrollment row
• ordering/referring flags by service category
• opt-out affidavit periods, specialty, address, and current-period calculation
• revalidation enrollment type, specialty, due dates, and reassignment counts
• revocation reasons, dates, and current re-enrollment-bar evidence
• query count, retrieval time, official CMS links, refresh cadence, and interpretation caveats

No-match searches produce one explicit NO_MATCHING_MEDICARE_ENROLLMENT_EVIDENCE item. Temporary failure of the required active-enrollment source produces SOURCE_UNAVAILABLE. If a supplemental source fails while the primary source succeeds, the provider record remains usable and names the affected source in supplementalSourceErrors.

Official sources and cadence

The actor uses CMS's public, no-key Data API and the stable latest dataset identifiers for:

1. Medicare Fee-For-Service Public Provider Enrollment
2. Order and Referring
3. Opt Out Affidavits
4. Revalidation Due Date List
5. Revoked Medicare Providers and Suppliers

The active-enrollment extract is a quarterly PECOS snapshot. Ordering/referring is refreshed frequently; opt-out and revalidation files are generally monthly; revocation data follows CMS publication updates.

Important interpretation limits

• CMS says the public PECOS-derived files are not real-time reporting; PECOS changes from day to day while public files update on their own schedules.
• Appearing in the active public extract means the provider was actively approved to bill Medicare or had completed an 855O when CMS produced the snapshot. It is not a complete credential, license, sanction, quality, or claims-payment determination.
• A missing active record does not by itself prove that a provider is ineligible, terminated, revoked, or unable to furnish any Medicare service.
• Ordering/referring flags are service-category evidence from CMS's published list; use the relevant CMS rules and current records for claims decisions.
• Opt-out, revalidation, and revocation records have distinct meanings. Do not collapse one into another.
• Names can change and an NPI can have multiple enrollment rows. Exact NPI, PAC ID, and enrollment ID evidence is stronger than name-only matching.
• Verify consequential credentialing, payment, network, or compliance decisions with CMS, the relevant Medicare Administrative Contractor, and current underlying records.

Pricing

This actor uses pay-per-event pricing. Check the live Apify Store pricing panel for current per-start and per-result rates.