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PECOS Lookup: Is This Provider Enrolled in Medicare?
Enter an NPI or a name. You see Medicare enrollment and revalidation due date, whether they can order and refer DME, lab, imaging and home health, any opt-out, and OIG, SAM.gov and state exclusion checks, in one search.
Search by NPI for an exact match, or by a provider’s name and state. Each result shows a Medicare status panel.
Search the NPI Registry
Search by NPI number, name, organization, city, ZIP code or specialty. Every result is checked against the OIG, SAM.gov and state Medicaid exclusion lists.
What This PECOS Lookup Shows
- Medicare enrollment: whether the NPI is on CMS’s Revalidation Due Date List, with state, provider type, specialty and the revalidation due date when CMS has set one.
- Ordering and referring: from CMS’s Order and Referring file, eligibility for Part B services, DME, home health, power mobility devices and hospice.
- Opt-out: whether the provider has an active Medicare opt-out, with start and end dates.
- Exclusions: the OIG list, SAM.gov and 32 state Medicaid lists, checked against the same NPI.
Who Needs a PECOS Check
Suppliers whose payment depends on someone else’s order: DME and medical supply companies, clinical labs, imaging centers and home health agencies. CMS requires the ordering or certifying provider to be enrolled in Medicare in an approved or opt-out status, with an individual NPI and an eligible specialty (CMS). Organization NPIs can’t order or certify.
Credentialing teams use the same check when onboarding a provider, and billers use it when a claim comes back denied for the ordering NPI.
What This Lookup Can’t Do
- It doesn’t sign in to PECOS or show pending applications; only the provider can see those.
- CMS files can lag a few weeks behind PECOS. A provider enrolled very recently may not appear yet.
- Not every enrolled provider is on the revalidation list at all times; “not found” means “confirm in PECOS”, not “not enrolled”.
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What is PECOS?
PECOS is the Provider Enrollment, Chain and Ownership System, CMS’s online system for Medicare enrollment. Providers use it to enroll, update and revalidate. Only the provider (or their delegate) can sign in, so others check enrollment through the public CMS data files this lookup uses.
How do I check if a doctor is enrolled in PECOS?
Search the provider’s NPI or name above. The Medicare status panel shows whether the NPI is on CMS’s enrollment (revalidation) list and whether they are eligible to order and refer. To see the provider’s own record and history, the provider signs in to PECOS.
Why do labs, DME suppliers and home health agencies check PECOS?
CMS says the provider who orders or certifies DMEPOS, clinical lab, imaging or home health must have an individual NPI, an eligible specialty and be enrolled in Medicare in an approved or opt-out status. If the ordering provider isn’t eligible, Medicare can deny the claim of the supplier who filled the order.
Can a provider who opted out of Medicare still order and refer?
Yes. CMS lists “opt-out” as an accepted status for ordering and certifying, so an opted-out physician can still order items and services that Medicare covers for the patient.
How often must providers revalidate?
Most providers and suppliers revalidate every 5 years and DMEPOS suppliers every 3 years. CMS publishes due dates only about six to seven months ahead; a missed revalidation can lead to a payment hold or deactivated billing privileges.
How current is this data?
The ordering and referring file is updated by CMS frequently and the enrollment and opt-out files monthly; we refresh our copy on every site update and show each file’s date with the result. For a billing decision, confirm in PECOS or with your Medicare contractor.
Sources: CMS: Ordering & Certifying · CMS data: Order and Referring file · CMS data: Revalidation Due Date List · CMS PECOS (sign-in) · LeadingAge NY: revalidation cycle (5 years; DMEPOS 3)
Information, not legal or billing advice. Data comes from public CMS, OIG, SAM.gov and state files and can lag behind the official systems; confirm on the official source before acting.