Primary source · 03 of 11
Provider Enrollment, Chain & Ownership System
PECOS verification
Medicare enrollment status, reassignments, opt-out status.
Issuing authority: Centers for Medicare & Medicaid Services (CMS)
What we verify
Medicare enrollment status (Approved, Pending, Revoked)
Reassignment of benefits to group practices
Opt-out status and effective dates
Revalidation due date
Specialty enrolled and effective date
Verification rules
How we decide pass / flag / block
- 01Status must be 'Approved' for a provider to bill Medicare.
- 02Revoked or Opt-Out status is a blocking discrepancy for any packet sent to a Medicare-participating receiver.
- 03Revalidation due within 60 days surfaces as a Material warning.
Example evidence
Example PECOS record (excerpt)
Stored alongside the credential with source URL, raw payload hash, and timestamp. Names and IDs below are illustrative.
Verified payload (excerpt)
enrollment_id
I20250114000123
status
Approved
specialty
Internal Medicine
effective_date
2018-08-01
revalidation_due
2027-08-01
reassignments
Acme Medical Group (TIN ****1234)
Refresh cadence
Every 24h
PECOS is re-queried every 24 hours. Status changes trigger immediate re-verification.
Source-down handling
When the authority is unreachable
If PECOS returns no record for the NPI, the field is flagged 'Not enrolled' and treated as informational unless the receiver requires Medicare participation.
Previous source
CAQH ProView
Council for Affordable Quality Healthcare
Next source
OIG LEIE
Office of Inspector General — List of Excluded Individuals/Entities