{
  "name": "medicare-provider-enrollment-mcp",
  "title": "HealthMesh · Medicare Provider Enrollment (PECOS) MCP",
  "version": "0.1.0",
  "description": "Medicare fee-for-service provider enrollment from CMS PECOS: search the quarterly Public Provider Enrollment file (~3M enrollments: NPI, enrollment ID, PECOS associate ID, provider/supplier type, state), provider-type counts by state, and checks of Medicare order/refer eligibility (Part B, DME, home health, power mobility, hospice; twice-weekly Order and Referring file) plus opt-out affidavits.",
  "healthmesh_domain": "Provider & Network",
  "datasets": [
    "PROV-03",
    "PROV-05"
  ],
  "mcp_endpoint": "https://medicare-provider-enrollment.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/medicare-provider-enrollment-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "CMS Medicare FFS Public Provider Enrollment (PECOS) + Order and Referring + Opt Out Affidavits (data.cms.gov)",
    "url": "https://data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/medicare-fee-for-service-public-provider-enrollment",
    "license": "U.S. Government Work (public domain) – https://www.usa.gov/government-works",
    "refresh": "row-level data live (data.cms.gov API, 6 h cache); provider-type counts weekly check via GitHub Actions"
  },
  "tools": [
    {
      "name": "pecos_search_enrollments",
      "title": "Search Medicare FFS provider enrollments (PECOS)",
      "description": "Searches the CMS Medicare Fee-For-Service Public Provider Enrollment file (PECOS; ~3M approved enrollments, quarterly) by NPI, name, organization, state or provider type, returning enrollment ID, PECOS associate control ID, provider/supplier type and enrollment state, with the exact total match count. Valid searches: npi alone; last_name (optionally + first_name, state, type); org_name (optionally + state, type); provider_type_cd + state. Use to confirm whether a provider is enrolled in Medicare and in which states and roles. The file has no city or address; use npi-registry tools for locations."
    },
    {
      "name": "pecos_list_provider_types",
      "title": "PECOS provider/supplier types with enrollment counts",
      "description": "Lists the PECOS provider and supplier type codes (e.g. 14-65 physical therapist in private practice, 12-49 ambulatory surgical center) with descriptions, category and counts of enrollments and distinct NPIs, nationally or for one state. Filter by keyword or category; sort by count. Use to find provider_type_cd values and to answer 'how many enrolled X are in state Y' questions."
    },
    {
      "name": "pecos_check_order_refer",
      "title": "Medicare order/refer eligibility for NPIs",
      "description": "Checks 1–100 NPIs against the CMS Medicare Order and Referring file (updated twice weekly): whether each may order or refer Part B services, DME, home health, power mobility devices and hospice. Optionally report a single service (no NPI is dropped). NPIs not in the file are not eligible to order/refer (claims citing them deny). Invalid NPIs are flagged."
    },
    {
      "name": "pecos_check_opt_out",
      "title": "Medicare opt-out affidavits",
      "description": "Searches CMS Medicare opt-out affidavits (~58k practitioners who opted out of Medicare and contract privately with beneficiaries; updated monthly) by NPI list, or by state, specialty and/or last name, returning opt-out effective and end dates, address, specialty and whether they may still order/refer. Use to explain why a practitioner is not in PECOS or cannot bill Medicare."
    },
    {
      "name": "pecos_describe_dataset",
      "title": "What this server covers",
      "description": "Sources, release dates, row counts, coverage rules and caveats for the Medicare provider enrollment tools (PECOS public enrollment file, Order and Referring file, opt-out affidavits)."
    }
  ]
}