An active NPI does not mean a provider can bill Medicare. Enrollment is a separate status, held in a CMS system called PECOS, and it can lapse while the NPI stays perfectly valid. If you bill, refer, credential, or recruit, the enrollment check is the one that protects you.
What PECOS is
PECOS is the Provider Enrollment, Chain, and Ownership System: CMS's record of who is approved to bill Medicare, under which practice arrangements, in which states. When people say a provider "is in PECOS," they mean Medicare enrollment is on file and active.
Why the check matters
- Claims. Services billed under a provider whose enrollment lapsed get denied.
- Orders and referrals. Medicare pays for ordered or referred services only when the ordering or referring clinician is enrolled or has validly opted out. An unenrolled referrer means the downstream claim fails, which is how one lapsed enrollment quietly breaks other people's revenue.
- Credentialing and hiring. A candidate's enrollment standing, and any gaps in it, is part of the paper trail worth reading before you commit.
How to check, in one minute
- Get the provider's NPI. Name plus state is enough to find it free.
- Pull their enrollment record. In NPivot's Provider Lookup, the Medicare Enrollment card shows whether enrollment is active and in which states, next to the registry record, licensure links, and revalidation date, all on one page with a free account.
- Read the dates, not just the status. An enrollment nearing revalidation deserves a follow-up look.
Revalidation: the date most people never check
Medicare requires providers to revalidate enrollment periodically, generally every five years, and every three for DMEPOS suppliers. CMS publishes the due dates. Miss one and billing privileges get deactivated even though nothing else changed. That makes the revalidation date two things at once: a compliance checkpoint, and a signal that a provider or group is actively reviewing their practice arrangements.
Opted out is not lapsed
Some providers formally opt out of Medicare and see patients under private contracts instead. Opt-out is a deliberate, on-file status that runs in two-year cycles, and opted-out providers can still order and refer. So a provider can be perfectly in good standing without being enrolled. The failure mode you are screening for is different: enrollment that ended without the provider noticing, or never existed at all.
Three facts, three checks
Enumerated, licensed, enrolled: an NPI proves the first, the state board proves the second, PECOS proves the third. No single number proves all three, which is exactly why NPivot puts the registry record, the license verification link, and the enrollment card on one profile.
Check any provider right now. The free NPivot NPI lookup searches the registry by name or number, no login required. A free account adds Medicare enrollment, prescribing, procedure volumes, and revalidation dates on one page.