{ "study": { "slug": "pecos-enrollment", "title": "Who is enrolled in Medicare? The nurse practitioner is now the most common clinician", "standfirst": "413,539 nurse practitioner enrollments make NPs the single most common clinician type in Medicare's provider-enrollment file — 13.9% of all 2.98 million PECOS records, nearly triple the largest physician specialty. Together, NPs and physician assistants are one in five enrollments. Advanced-practice providers now anchor the Medicare workforce.", "desk": "workforce", "article_type": "Original Research", "published": "2026-06-11", "issue": 54, "doi": "10.5072/fonteum/pecos-enrollment-2026", "url": "https://fonteum.com/research/pecos-enrollment", "methodology_version": "pecos-enrollment/v1" }, "data_as_of": "2026-05-28", "datasets": [ { "slug": "cms-pecos", "name": "CMS PECOS", "publisher": "CMS — Provider Enrollment, Chain & Ownership System", "upstream_url": null } ], "key_findings": [ { "number": "2.98M", "finding": "active Medicare provider-enrollment records in PECOS (2,981,799), spanning 2,556,656 distinct NPIs across 56 states and territories", "dataset": "cms-pecos" }, { "number": "413,539", "finding": "nurse-practitioner enrollments — 13.9% of the file, the single largest provider type, ahead of every individual physician specialty", "dataset": "cms-pecos" }, { "number": "20.4%", "finding": "of all enrollments are nurse practitioners or physician assistants (609,027 records) — one in five of the entire Medicare enrollment file", "dataset": "cms-pecos" }, { "number": "2.87×", "finding": "as many nurse-practitioner enrollments as internal-medicine physician enrollments (144,202), the largest single physician specialty in the file", "dataset": "cms-pecos" } ], "faqs": [ { "q": "What is PECOS / Medicare provider enrollment?", "a": "PECOS is the Provider Enrollment, Chain and Ownership System — the federal system of record for who is approved to bill Medicare. Enrollment, governed by 42 CFR Part 424 Subpart P, validates a provider's eligibility, confirms practice locations and owners, and grants Medicare billing privileges via a Form CMS-855 application." }, { "q": "Why are nurse practitioners the most common Medicare clinician?", "a": "Two forces. State scope-of-practice laws have steadily expanded what NPs may do independently, and health systems lean on advanced-practice providers to fill access gaps as primary-care physician supply flattens. MedPAC reports NPs and physician assistants now deliver about a quarter of all Medicare clinician visits." }, { "q": "Does enrolling in PECOS mean Medicare pays the provider in full?", "a": "Not necessarily. Enrollment grants billing privileges; it does not set the payment rate. When a service is billed under a nurse practitioner's or physician assistant's own NPI, Medicare generally pays 85% of the physician fee schedule rate — versus 100% when the same service is billed incident-to a supervising physician." }, { "q": "What is the difference between PECOS and NPPES?", "a": "NPPES issues the National Provider Identifier — an identity record every provider holds. PECOS is the enrollment and billing-privileges layer on top of it: a provider can have an NPI in NPPES without an active Medicare enrollment in PECOS. This study counts PECOS enrollment records, not NPPES identities." }, { "q": "Why are there more enrollment records than providers?", "a": "Because enrollment is per provider type and location, not per person. A clinician who enrolls under two provider types, or a supplier enrolling multiple practice locations, generates several PECOS records under one NPI. The file holds 2,981,799 records across 2,556,656 distinct NPIs — about 1.17 records per provider." }, { "q": "Is a provider type the same as what the clinician actually does?", "a": "Roughly, not exactly. The provider_type_desc field is CMS's own enrollment taxonomy — 325 categories spanning clinicians, suppliers, and organizational entities such as clinics and group practices. It reflects the basis on which a provider enrolled to bill Medicare, which usually but not always tracks their day-to-day clinical role." }, { "q": "Can I reproduce these numbers?", "a": "Yes. Every figure is a direct count over the 2,981,799-record pecos_providers table from the 2026-05-28 federal release. The exact SQL is published in the reproducibility block below and on the PECOS dataset page. Each count resolves to specific rows in a specific frozen federal snapshot." } ], "citation": { "apa": "Fonteum Research. (2026, June 11). Who is enrolled in Medicare? The nurse practitioner is now the most common clinician. Fonteum Research, Issue 54. https://doi.org/10.5072/fonteum/pecos-enrollment-2026", "url": "https://fonteum.com/research/pecos-enrollment" }, "reproducible_sql": "-- Medicare provider enrollment (PECOS), explained — fully reproducible query.\n--\n-- Source: CMS PECOS Ordering & Referring / provider-enrollment extract.\n-- Snapshot: cms-pecos / federal release 2026-05-28, 2,981,799 enrollment records.\n-- Table: public.pecos_providers (public, read-only).\n-- Identity: one row = one Medicare provider-enrollment record, keyed by NPI +\n-- provider_type_cd. A single NPI can hold multiple enrollment records\n-- (different provider types / states), so records > distinct NPIs.\n--\n-- Every headline figure in the study resolves to one of the rows below.\nWITH totals AS (\n SELECT\n count(*) AS enrollment_records,\n count(DISTINCT npi) AS distinct_providers,\n count(*) FILTER (WHERE org_name IS NOT NULL AND org_name <> '') AS org_records,\n count(*) FILTER (WHERE last_name IS NOT NULL AND last_name <> '') AS individual_records,\n count(DISTINCT provider_type_desc) AS distinct_provider_types,\n count(DISTINCT state_cd) AS jurisdictions,\n max(source_release_date) AS federal_release\n FROM public.pecos_providers\n)\nSELECT\n t.enrollment_records, -- 2,981,799\n t.distinct_providers, -- 2,556,656\n round(t.enrollment_records::numeric / t.distinct_providers, 3)\n AS records_per_provider, -- 1.166\n t.org_records, -- 433,496\n t.individual_records, -- 2,548,303\n round(100.0 * t.org_records / t.enrollment_records, 1)\n AS org_pct, -- 14.5%\n t.distinct_provider_types, -- 325\n t.jurisdictions, -- 56\n t.federal_release -- 2026-05-28\nFROM totals t;\n\n-- Most-enrolled provider types (top 6 by enrollment-record volume):\nSELECT\n provider_type_desc AS provider_type,\n count(*) AS records,\n round(100.0 * count(*) / sum(count(*)) OVER (), 2) AS pct\nFROM public.pecos_providers\nGROUP BY provider_type_desc\nORDER BY records DESC\nLIMIT 6;\n-- PRACTITIONER - NURSE PRACTITIONER 413,539 13.87 <- single largest type\n-- PART B SUPPLIER - CLINIC/GROUP PRACTICE 239,492 8.03 <- largest organizational type\n-- PRACTITIONER - PHYSICIAN ASSISTANT 195,488 6.56\n-- PRACTITIONER - INTERNAL MEDICINE 144,202 4.84 <- largest single physician specialty\n-- PRACTITIONER - FAMILY PRACTICE 129,130 4.33\n-- PRACTITIONER - PHYSICAL THERAPIST IN PRIVATE... 126,499 4.24\n\n-- Advanced-practice share (NP + PA) and the NP-to-physician ratio:\nSELECT\n (SELECT count(*) FROM public.pecos_providers\n WHERE provider_type_desc IN ('PRACTITIONER - NURSE PRACTITIONER',\n 'PRACTITIONER - PHYSICIAN ASSISTANT')) AS np_pa_records, -- 609,027\n round(100.0 * (SELECT count(*) FROM public.pecos_providers\n WHERE provider_type_desc IN ('PRACTITIONER - NURSE PRACTITIONER',\n 'PRACTITIONER - PHYSICIAN ASSISTANT'))\n / (SELECT count(*) FROM public.pecos_providers), 2) AS np_pa_pct, -- 20.42%\n round(\n (SELECT count(*)::numeric FROM public.pecos_providers\n WHERE provider_type_desc = 'PRACTITIONER - NURSE PRACTITIONER')\n / (SELECT count(*) FROM public.pecos_providers\n WHERE provider_type_desc = 'PRACTITIONER - INTERNAL MEDICINE'), 2) AS np_to_internal_med_ratio; -- 2.87\n\n-- State concentration (top 5 by enrollment records):\nSELECT\n state_cd AS state,\n count(*) AS records,\n round(100.0 * count(*) / sum(count(*)) OVER (), 2) AS pct\nFROM public.pecos_providers\nGROUP BY state_cd\nORDER BY records DESC\nLIMIT 5;\n-- CA 262,214 8.79\n-- TX 207,328 6.95\n-- NY 198,758 6.67\n-- FL 185,769 6.23\n-- PA 127,899 4.29", "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included." }