API Endpoint: Medicare Enrollment

The medicare-enrollment endpoint checks whether a provider is enrolled in Medicare or has opted out, by NPI.

POST `/api/v1/validate/medicare-enrollment`

https://www.tincomply.com/api/v1/validate/medicare-enrollment

Checks a provider's Medicare status by NPI: enrolled privileges (Part B, DME, home health, power mobility, hospice), opt-out status with its effective and end dates, and Care Compare profile details.

Request body

Field	Type	Description
`npi`required	string	The 10-digit NPI.

Response object: `medicareEnrollmentResult`

Field	Type	Description
`found`	bool	True when the NPI is enrolled in Medicare.
`invalidCheckDigit`	bool	True when the NPI fails its check-digit test.
`providerName`	string	Provider name on the Medicare record.
`optedOut`	bool	True when the provider has opted out of Medicare.
`optOutEffectiveDate, optOutEndDate`	datetime	Opt-out period.
`optOutSpecialty`	string	Specialty on the opt-out affidavit.
`partB, dme, homeHealth, pmd, hospice`	bool	Enrolled Medicare privileges.
`careCompare`	object	credential, medicalSchool, graduationYear, primarySpecialty, secondarySpecialties, telehealth, acceptsAssignment and locations.
`retrievedOn`	datetime	When we retrieved the record.
`message`	string	Human-readable summary of the result.
`completed`	bool	False when the upstream source was unavailable and the request is queued for retry.

The sample shows an opted-out provider. Claims to federal programs for an opted-out provider's services are not payable, so treat optedOut as a stop for Medicare billing.

Sample request

curl -X POST https://www.tincomply.com/api/v1/validate/medicare-enrollment \ -H "X-API-Key: YOUR_API_KEY" \ -H "Content-Type: application/json" \ -d '{"npi":"1245319599"}'

Sample response

{
  "id": "jo6nPgXaj0OXUKZMyZCkXgDg",
  "request": {
    "npi": "1245319599",
    "requestDate": "2026-10-06T03:03:13Z",
    "requestedServices": "medicare-enrollment"
  },
  "medicareEnrollmentResult": {
    "npi": "1245319599",
    "message": "Opted out of Medicare",
    "found": false,
    "completed": true,
    "invalidCheckDigit": false,
    "providerName": "TEST PROVIDER",
    "optedOut": true,
    "optOutEffectiveDate": "2022-07-01T00:00:00",
    "optOutEndDate": "2028-07-01T00:00:00",
    "optOutSpecialty": "Psychiatry",
    "careCompare": {
      "credential": "MD",
      "medicalSchool": "TEST UNIVERSITY SCHOOL OF MEDICINE",
      "graduationYear": 2004,
      "primarySpecialty": "INTERNAL MEDICINE",
      "telehealth": true,
      "acceptsAssignment": "Y",
      "locations": [
        {
          "facilityName": "TEST MEDICAL GROUP",
          "groupSize": 42,
          "singleLine": "1 TEST WAY, SUITE 200, BALTIMORE, MD 21201-0000",
          "phone": "4105550120"
        }
      ]
    },
    "partB": false,
    "dme": false,
    "homeHealth": false,
    "pmd": false,
    "hospice": false,
    "retrievedOn": "2026-10-06T03:03:13Z"
  }
}

Errors

Requests that cannot be processed return HTTP 400 with an object keyed by field name, each listing what was wrong. Authentication, permission and other status codes are covered in the API overview.

This endpoint requires an API key with the Validate permission.

See how this check works in the portal and what it costs: NPI & Medicare Verification