The Rise of the Nurse Practitioner

Nurse practitioners are reshaping American healthcare — and Medicare data proves it. With 1.2M provider records over the past decade, NPs represent 11.4% of all Medicare providers — the largest single provider type in the system. They've billed $31.5B in total payments. But at an average of just $25.9K per provider, they earn a fraction of what specialists make.

The Pay Gap: $25.9K vs $383.7K

The average nurse practitioner bills Medicare $25.9K per year. The average ophthalmologist bills $383.7K. That's a 15x difference — and it reflects a fundamental structural divide in how Medicare values different types of care.

The Highest-Paid Specialties

While NPs earn $25.9K on average, the top-earning specialties paint a very different picture of Medicare income:

But Some NPs Bill Millions

The average NP bills $25.9K. But averages can be deceiving. At the extreme end, individual nurse practitioners have billed Medicare millions of dollars — volumes that would be extraordinary even for physicians.

Taheri isn't alone. Our data reveals dozens of NPs billing well over $1 million per year — volumes that raise questions about whether the services were actually performed by the NP, delegated to others under "incident-to" billing, or in some cases, not performed at all.

The Scope of Practice Debate

At the heart of the NP boom is one of healthcare's most contentious policy debates: should nurse practitioners practice independently, or should they require physician supervision?

As of 2025, 27 states plus DC grant NPs full practice authority — meaning they can evaluate patients, diagnose conditions, prescribe medications, and bill Medicare without physician oversight. The remaining states require varying degrees of collaborative agreements or supervision.

The American Medical Association argues that NPs lack the training depth of physicians (NP programs require ~500-1,500 clinical hours vs ~15,000+ for physicians) and that independent practice poses patient safety risks. The American Association of Nurse Practitioners counters that decades of research show comparable outcomes for primary care conditions and that NPs are filling a critical provider shortage.

Filling the Gap

The numbers support the "filling the gap" narrative. With 1.2M NP billing records vs 917.6K for internal medicine and 804.1K for family practice, NPs have become the backbone of primary care access in many communities.

In rural areas especially, NPs may be the only providers accepting new Medicare patients. The average NP sees 652 services per year — a manageable patient load that suggests genuine clinical practice, not just billing optimization.

Or Creating New Billing Opportunities?

Critics point to a different pattern. Some healthcare companies have hired armies of NPs specifically because they're cheaper to employ than physicians but can bill Medicare at 85% of physician rates (or 100% under "incident-to" billing when supervised by a physician). The math is straightforward:

• Physician salary: $250K-$400K
• NP salary: $100K-$130K
• NP Medicare billing: 85-100% of physician rates
• Margin per NP: significantly higher than per physician

Corporate medicine has noticed. Large healthcare organizations increasingly staff clinics with NPs while a single supervising physician oversees multiple locations — a model that maximizes billing volume per dollar of labor cost.

What the Data Says

NPs billed $31.5B to Medicare over the decade — 3.7% of total Medicare spending. Their markup ratio of 3.5x is close to the system average, suggesting billing practices largely in line with norms.

The real story isn't fraud — it's structural change. Medicare is being delivered by a fundamentally different workforce than it was 20 years ago, and the system hasn't fully caught up. Payment rates, supervision requirements, and fraud detection algorithms were all designed for a physician-centric system. The NP boom demands a rethink.