Medicare Facility Mix: 68K Providers in the CMS POS Registry

The CMS Provider of Services (POS) file is published by CMS as part of the iQIES (Internet Quality Improvement and Evaluation System) program. It is the most comprehensive single-file registry of Medicare-certified facilities in the United States — more comprehensive than any individual Care Compare dataset because it covers every certified provider type rather than a specialty-specific subset.

A CMS Certification Number (CCN) is the unique identifier for every Medicare-certified facility. The CCN is the join key for all Care Compare datasets (nursing home quality, hospice, home health, dialysis, hospitals). Without a clean POS table, cross-source joins lack a validated facility identity anchor.

The POS file is published as an annual ZIP at CMS's provider-characteristics portal. It contains approximately 200K–300K columns across multiple provider sheets; the Fonteum ingest captured the headline identity fields (CCN, facility name, provider type, address, state, participation date) into the cms_pos_facilities table.

Source: CMS Provider of Services File (iQIES), public federal dataset. Snapshot 2026-05-25.

The named facility types in the 2026-05-25 snapshot:

The 50,514 NULL provider_type records are not missing data. They represent:

• Skilled Nursing Facilities (SNFs) and nursing homes
• Physician group practices with CCNs
• Durable Medical Equipment (DME) suppliers
• Other facility types whose POS type codes were not parsed in the initial ingest

All 68,211 records carry a valid CCN — the table is a complete CCN backbone regardless of the provider_type NULL rate.

Numbers confirmed 2026-05-25 via direct query on cms_pos_facilities.

Top 10 states by facility count (2026-05-25 snapshot):

California and Texas together hold 28% of all facilities. The top 10 states account for more than half of all 68,211 records.

State distribution reflects Medicaid/Medicare enrollment volumes, population size, and the density of facility types (HHAs tend to concentrate in high-population states; LTACHs are rarer everywhere).

The CMS Certification Number (CCN) is a 6-character alphanumeric code that uniquely identifies every Medicare-certified facility. The CCN is the primary join key across all CMS data:

• CMS Care Compare Nursing Home Compare → joins via CCN
• CMS Care Compare Hospice Compare → joins via CCN
• CMS Care Compare Home Health Compare → joins via CCN
• CMS Care Compare Dialysis → joins via CCN
• CMS Care Compare Hospitals → joins via CCN
• PBJ Daily Nurse Staffing data → joins via CCN

The cms_pos_facilities table with 68,211 CCN records is the Fonteum identity backbone that enables all of these joins. A facility's full name, address, and state from POS can be attached to its quality ratings, staffing data, or deficiency records via a single CCN join.

Approximately 74% of Care Compare records join back to a POS row — the 26% non-match reflects facilities that appear in Care Compare but have not yet been matched or that use subsidiary CCN variants not in the base POS extract.

• Snapshot date. Numbers reflect the POS file ingested on 2026-05-25. CMS publishes annual updates; the file should be re-ingested after each annual CMS release.
• NULL provider_type. 74.1% of records have a NULL provider_type. This is an ingest artifact, not a data quality failure — every record carries a valid CCN. The NULL rate will decrease as the type-code parser is extended to cover SNF, nursing home, DME, and physician-group codes.
• Not a complete billing registry. The POS file covers Medicare-certified facilities. It does not include providers who bill Medicare Part B via a group practice without a facility CCN, or providers who participate only in state Medicaid programs without a federal certification.
• Annual cadence. POS is an annual snapshot, not a real-time registry. Facility openings, closings, and ownership changes between annual publications are not reflected until the next release.
• No quality signal. The POS file is a facility identity and enrollment registry. It does not contain quality ratings, deficiency data, or outcome measures — those come from the Care Compare datasets that join via CCN.

Source. CMS Provider of Services File (iQIES), public federal dataset, published at data.cms.gov. Annual release; ingested 2026-05-25.

Ingestion. The POS ZIP was downloaded and the non-hospital facility sheet parsed. Identity columns (CCN, facility_name, provider_type, provider_type_code, address, city, state, zip, participation_date) were upserted into cms_pos_facilities via the §sprint1-cms-pos-file operator script. Table uses CCN as the upsert key; RLS Pattern B (public read, writes denied).

Aggregation. All counts confirmed by direct SQL query on cms_pos_facilities on 2026-05-25. Facility-type counts use the provider_type column; NULL counts use IS NULL. State counts use the state column.

Doctrine. Tier-2 research snapshot under doctrine v1.6 LOCKED-HEALTHCARE-ONLY-SCOPE. POS is cross-vertical (covers all Medicare facility types). No facility profile writes in this study.