clinicians.build · interactive · september 2, 2026

Ten Calls

Brendan Keeler on Scan.com's $220M raise: a network is the most durable business in healthcare, and “the network label does not come for free.” Below are two thousand dots. Each one is a tenth of a percent of Medicare volume — lab on the left, imaging on the right. Give the same instruction to both: integrate the biggest players first.

Primary source: Health API Guy (Brendan Keeler), “Scanning for a Network,” September 1, 2026
Data via MIMI Labs: CMS Medicare Physician & Other Practitioners, performance year 2024
Lab 327,453,249 services / 163,177 NPIs · Imaging 111,933,922 services / 174,484 NPIs

Read “Scanning for a Network” → CMS source data → Or read today's newsletter →

endpoints integrated 1 largest biller only

Lab & pathology

4.42%

44 of 1,000 dots lit · LabCorp, Quest, Unilab

Imaging

0.51%

5 of 1,000 dots lit · mobile x-ray vendors you've never heard of

lab4.4%

imaging0.5%

Same budget. Same instruction. One of these is a network you can launch with.

Pharmacy got Surescripts. Imaging and labs did not, and the usual explanation is regulatory — e-prescribing had a mandate, planned care never did. True, and incomplete. The other half is a counting problem: a network only launches if a small number of endpoints holds enough volume that early coverage is worth paying for.

In Medicare lab, two companies clear that bar on their own. LabCorp and Quest entities occupy all five top slots, and the single largest NPI is 4.42% of every lab service in the program. Ten endpoints reach 22.3%; a hundred reach 52.6%. That is a launchable network, whether or not anyone launched one.

In imaging, the largest biller in the United States is 0.51%, and it is Symphony Diagnostic Services — a mobile x-ray company. Ten endpoints reach 1.08%. A hundred reach 3.03%. To touch half the volume you need roughly 10,800 separate integrations.

80/20 lens

Reaching 80% of Medicare imaging volume takes about 28,700 endpoints. The same 80% in lab takes about 3,800. If your product depends on getting an outside image, there is no version of “partner with the majors” that gets you coverage — the majors are 3% of the market. Budget for the fax, the phone call and the CD-ROM on day one. Then ask the harder question: is retrieval a cost you absorb, or is retrieval the product?

What this can't tell you

An NPI is not an integration endpoint. Under Part B carrier claims, most imaging is billed by the radiologist who read the study, not the facility that acquired it. Restrict to organizational NPIs and you find only 2,289 of them billing imaging — but they carry just 4.3% of the volume, so that view is a different tiny slice, not a cleaner census. The real endpoint count sits between the two and no public dataset publishes it.
Medicare Part B fee-for-service only. No Medicare Advantage, no commercial, no cash-pay — and Scan.com's actual US wedge, per Keeler, is personal injury litigation, which is none of the above.
Hospital outpatient imaging is largely missing. These are physician/supplier claims; a large share of US imaging bills through a different CMS file. Read this as the independent-and-professional slice of the modality.
Concentration is necessary, not sufficient. Lab is concentrated and still never produced a Surescripts. Counting endpoints tells you a network is possible. It does not tell you who pays for the transaction.