Exclusive Provider Organization: how many are there, and how many are in private practice?

National totals

What this specialty covers

(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.

Reading the sole-proprietor share

For this specialty, the sole-proprietor share describes how NPPES registrants reported their organization status, not how many EPOs operate as private practices. The sole-proprietor flag is a self-reported NPPES field and an imperfect proxy because it does not show ownership, network structure, reimbursement arrangements, or whether an organization is independently operated.

By state

New NPI registrations by year

Counts reflect the year each NPI was first issued, among records still active today. The final year is partial: this data covers through 2026-01-11.

Data notes

• The sole-proprietor field is self-reported by the provider in NPPES and is an imperfect proxy for private practice.
• A sole-proprietor count shown as <11 is suppressed: the true value is below 11, which could include zero.
• NPI counts represent active records with this primary taxonomy, not necessarily distinct operating organizations or complete market participation.
• Taxonomy selection and organization details come from NPPES records and may be incomplete, outdated, or changed over time.
• Providers are counted once, by their primary taxonomy code only.

Source: CMS National Plan and Provider Enumeration System (NPPES) Data Dissemination file, FOIA-disclosable public data under CMS-6060-N. Aggregated by Hero EMR on 2026-08-03; deactivated NPIs excluded; specialty assigned from the primary taxonomy code (NUCC 25.1). Counts below 11 are suppressed. Individual providers are never published. All provider data pages.

Common questions