Largest hospital systems in the US: hospitals, beds and revenue from CMS records

This list is for companies that sell to hospitals (medical device, supply, staffing, software, revenue cycle and facilities vendors) and for anyone who needs a sourced answer to which health systems are biggest. It's built from three public federal datasets you can download yourself: the Centers for Medicare & Medicaid Services (CMS) Hospital Enrollments and Hospital All Owners files (September 2026 release) and the CMS Hospital Provider Cost Report for 2024. For the public companies, we also show their own hospital counts from their 10-Ks.

The 25 hospital systems with the most hospitals

Hospitals are Medicare-certified hospitals (six-digit CMS Certification Numbers, excluding psychiatric and rehabilitation units inside other hospitals) whose CMS ownership record lists the system's parent organization as an owner or as having operational or managerial control, in the Hospital All Owners and Hospital Enrollments files released in September 2026. Beds, net patient revenue and full-time equivalent (FTE) employees on payroll are summed from each hospital's 2024 cost report; a few hospitals had no 2024 report on file. "Based in" is the parent's address in the CMS ownership record. Ownership follows each hospital's enrollment as proprietary or nonprofit. Just outside the 25: Ardent Health (29 hospitals) and CHRISTUS Health (26).

The largest systems by revenue

Ranked by the net patient revenue their hospitals reported in 2024 cost reports, among the systems we linked:

All US hospitals together reported $1.5 trillion of net patient revenue in their 2024 cost reports, so HCA's hospitals account for about 4%. Revenue is a better guide to buying power than hospital count: Kaiser has half as many hospitals as Ascension but more revenue, and Northwell, with 19 hospitals, outsells Tenet's 65.

How the companies count their own hospitals

The CMS count and a company's own count differ, because one Medicare provider number can cover several campuses and companies count facilities their own way. From the latest 10-Ks:

Tenet's CMS count is higher than its own because 24 of the 65 hospitals CMS links to it also list an entity of USPI, Tenet's ambulatory surgery business, as an owner. Acadia's is lower because its 277 facilities include specialty treatment facilities, comprehensive treatment centers and residential programs, not only psychiatric hospitals. When a buyer quotes a hospital count, ask which kind.

How we built the list

1. Hospitals. We took every six-digit CMS Certification Number in the Hospital Enrollments file (4,527 hospitals, 1,376 critical access hospitals and 57 rural emergency hospitals) and joined the Hospital All Owners file, which lists each enrollment's owners and controlling organizations.
2. Systems. We grouped hospitals under the parent organization named in those records (for example HCA Healthcare Inc, CommonSpirit Health, Ascension Health), adding subsidiaries that appear as owners under their own names when most of their hospitals already list the parent (23 of Atrium Health's 24 hospitals also list Advocate Health, and 34 of Dignity Health's 42 list CommonSpirit).
3. Size. Beds, net patient revenue and FTEs come from the 2024 Hospital Provider Cost Report, which covers fiscal years that began in 2024. Revenue is net patient revenue only, not a system's total revenue, which also includes physician groups, insurance plans and other businesses.
4. Limits. Ownership records are filed by each hospital, and some don't name their parent. Large academic systems are most affected: Massachusetts General Hospital's record doesn't link it to Mass General Brigham, for example, so that system appears smaller than it is and isn't ranked. Department of Veterans Affairs hospitals are largely absent from these Medicare files, so the VA isn't ranked.

Commercial databases and trade publications publish their own rankings by hospitals, staffed beds and revenue. They use proprietary system definitions, so their counts won't match these.

What the list is good for if you sell to hospitals

Know which kind of system you're calling. Acute care systems (HCA, CommonSpirit, Ascension, Trinity) buy for emergency departments, operating rooms and inpatient units. Post-acute operators (Encompass, Select Medical, Kindred Hospitals, PAM, Ernest) buy for therapy and long stays at many similar small hospitals. Behavioral operators (UHS, Acadia) buy for psychiatric care and safety. Rural systems (Sanford, Mercy, Avera) run many critical access hospitals, which federal rules limit to 25 inpatient beds.

Expect decisions at system level. In most multi-hospital systems, supply chain, IT and revenue cycle are run centrally, product decisions go through a value analysis process with clinical input, and a single hospital rarely buys alone. The champion is often a department leader at one hospital; the buyer is the system. This is general guidance; for-profit chains tend to centralize more than nonprofit systems. Our guide to selling to hospitals covers the buying committee, and how to find decision makers covers reaching the right executive.

Size every account from the cost report. Each hospital's beds, FTEs, discharges and net patient revenue are public. That's enough to estimate a seat, bed or volume-based price for every target before the first call. For the full hospital universe, see our list of hospitals.

Worked example

Illustrative example. Shiftline (shiftline.example) sells nurse scheduling software for $8 per hospital FTE per month. Its account executive sizes two systems from the table:

• Trinity Health: 74,984 FTEs across 71 hospitals. Full deployment: 74,984 x $8 x 12 = about $7.2 million a year. Average per hospital: about 1,056 FTEs, or about $101,000 a year.
• Sanford Health: 23,908 FTEs across 34 hospitals, 20 of them critical access. Full deployment: about $2.3 million a year. A typical critical access hospital may have only a few dozen to a few hundred staff, so Sanford is a system deal or nothing.

The plan: at Trinity, win one regional hospital group with a nursing executive as champion and expand through the system's value analysis process; at Sanford, pitch the system from the start. At volume, researching each system's structure and the people inside it is the slow part; Bebop researches each account and finds the contacts.

Next step: see how hospital buying committees work in our guide to selling to hospitals.