How to Find a Primary Care Provider: Family Medicine, Internal Medicine and NPs

What primary care covers

HealthCare.gov's glossary defines a primary care provider as a physician (MD or DO), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services. In practice that means a regular clinician who knows your history, handles common problems and preventive care, manages long-term conditions, and sends you to specialists when you need them.

Having one matters for coverage too. Medicare.gov's HMO page says most Medicare Advantage HMOs require you to choose a primary care doctor and, in most cases, to get a referral from them to see a specialist.

Types of primary care physicians

Physicians who give primary care usually register one of a few specialty codes in their NPI record. The definitions below come from the NUCC Health Care Provider Taxonomy, the code set that NPI records and profiles on this site use.

Family medicine

NUCC describes family medicine as the specialty concerned with the total health care of the individual and the family, whose scope is not limited by age, sex, organ system or disease. A family physician can often see children, parents and grandparents in the same practice.

Internal medicine

An internist, in NUCC's definition, provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly, and is trained in the essentials of primary care, including disease prevention and wellness. Internal medicine is also the base for subspecialties such as cardiology, so an "internal medicine" code alone does not tell you whether a physician practices primary care or a subspecialty. Ask the office.

Geriatric medicine

NUCC describes a geriatric medicine physician as a family medicine or internal medicine physician with special knowledge of the aging process, who cares for older patients at home, in the office, in long-term care settings such as nursing homes, and in the hospital.

Pediatrics

A pediatrician, per NUCC, is concerned with the physical, emotional and social health of children from birth to young adulthood, from preventive care to the treatment of acute and chronic diseases.

General practice

Some physicians register the general practice code, which NUCC describes as diagnosing, treating and managing patients with a variety of illnesses and conditions.

Nurse practitioners and physician assistants in primary care

Many primary care practices include nurse practitioners (NPs) and physician assistants (PAs), and some patients see one as their main clinician.

• Nurse practitioners: NUCC describes an NP as a registered nurse with a graduate degree in nursing prepared for advanced practice, who provides primary health care services in accordance with state nurse practice laws. NP specialties include family, gerontological and pediatric nurse practitioners.
• Physician assistants: NUCC describes PAs as licensed by the state and practicing within the scope of that license. They take medical histories, perform physical exams and order lab tests and x-rays, and in some states may prescribe. NUCC notes that most states require them to work under the supervision of a physician.

What an NP or PA may do on their own depends on state law, so the rules differ from state to state. Medicare.gov's page on doctor and other health care provider services lists both among the providers whose services Part B covers. Our credentials guide explains the training behind each title.

Step 1: start with your coverage

If you have a health plan with a network

Use the plan's provider directory and filter for primary care. Federal rules at 45 CFR 147.138 say that when a group or individual plan requires or allows you to designate a primary care provider, it must let you choose any participating primary care provider who is available to accept you, and must let you choose an in-network pediatrician for a child. Then call the office to confirm it is still in the plan's network.

If you have Original Medicare

There is no network, but it matters whether the practice accepts assignment. Medicare.gov's assignment page explains that a provider who accepts assignment agrees to charge you only the Medicare deductible and coinsurance, while a non-participating provider who does not accept assignment can in many cases charge up to 15% more than the Medicare-approved amount. Profiles on this site show whether CMS's Doctors and Clinicians file lists a clinician as accepting assignment; confirm with the office. Our assignment guide has the details.

Step 2: why "accepting new patients" needs a phone call

No public dataset we use says whether a practice is taking new patients, how long the wait is, or which plans it currently takes. T-MedInfo does not show this information, and we do not guess it. Medicare.gov's doctor services page gives the same advice: check with the doctor or group practice to find out whether they are accepting new patients. It also notes that if you have not had services from a doctor or group practice in the last 3 years, they may consider you a new patient.

When you call, it helps to ask:

• Are you accepting new patients with my insurance, and how soon is the first available appointment?
• Which clinicians in the practice take new patients: physicians, NPs, PAs?
• Can I get same-day or next-day visits when I am sick? Do you offer video visits or an after-hours line?
• Which hospital do your physicians work with, and who cares for patients if they are admitted?
• What do you need from me before the first visit, such as records from my previous clinician?

Step 3: check the basics

Before your first visit, a few public records are worth a look:

• License: physicians and PAs are licensed by the state medical board, which you can find through the FSMB's list of state medical boards. Nurse practitioners are licensed by the state board of nursing, and many states' nurse licenses can be looked up in Nursys. Our license guide explains how.
• Specialty codes: a profile on this site shows the taxonomy codes in the clinician's NPI record. The codes are self-reported and do not prove training or board certification.
• Practice location: profiles show the practice address from the NPI record. Confirm it with the office, because clinicians move and records can lag.

Step 4: make the first visit count

If you are new to Medicare, Part B covers a one-time "Welcome to Medicare" preventive visit within your first 12 months of Part B, and after that a yearly Wellness visit. You pay nothing for these when the provider accepts assignment, although extra tests or services in the same visit may cost you. Neither is a routine physical exam. They are a good way to set up a prevention plan with a new primary care clinician.

Bring a list of all your medicines, including over-the-counter drugs and supplements, your past medical records if you have them, your family health history and your questions.

How to use T-MedInfo to find primary care

1. Browse your city from the city listings below and open the family medicine, internal medicine, pediatrics or nurse practitioner listings, or search by name.
2. On a profile, check the specialty codes, practice address, state board link and, where CMS lists it, Medicare assignment.
3. Check network status with your plan's directory.
4. Call the office to ask about new patients and appointment times.

Our listings show clinicians registered at an address in your area. They do not rank clinicians by quality, and they do not show availability.