February 5, 2010

CMS Releases PECOS Enrollment List

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The Centers for Medicare and Medicaid Services (CMS) has made available the list of physicians and non-physician practitioners who are eligible to both order and refer under Medicare and who are enrolled in the Provider Enrollment, Chain and Ownership System (PECOS). The 13,653-page file comprises a simple alphabetical list of the enrolled providers—from Diane A Akert to Nathan Zziwambazza—along with their National Provider Identifier (NPI) numbers. The file was released in anticipation of the April 5 deadline after which durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims will be rejected if the referring provider is not correctly listed in the PECOS database, along with his or her provider number.

A CMS Common Electronic Data Interchange (CEDI) document noted that CMS had added some 220,000 NPIs to the previous PECOS roster, adding, “With this update to the PECOS records, CEDI has seen a drop in the number of warning messages being produced” on submitted claims.

CMS stated in a provider bulletin, “A new file will be made available periodically that will replace the posted file; at any given time, only one file (the most recent) will be available…. The file can be viewed online. In addition, it can be downloaded by users with technical expertise and further sorted or manipulated. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name. Please note the following:

  1. Records are in alphabetical order based on the surname of the physician or non-physician practitioner.
  2. Name suffixes (e.g., Jr.), if they exist, are not displayed.
  3. There are no duplicates in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness.
  4. Deceased physicians and non-physician practitioners are not included in the file.
  5. If a user is unsure of a physician or non-physician practitioner’s NPI, he or she can look it up in the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. Keep in mind that the record in the NPI Registry is not the Medicare PECOS enrollment record.”


CMS also noted that it typically takes up to 60 days for a provider’s new Medicare application to be approved and the provider to be listed on the PECOS database.

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