Offices of Other Health Practitioners (U.S.) — NAICS 6213

A Histometrics rollup primer for a general investing audience — relevant to both public-market and private investors. NAICS = North American Industry Classification System, the federal code set that groups businesses by activity. This page covers the four-digit industry group 6213, which sits inside the three-digit subsector 621 "Ambulatory Health Care Services." It synthesizes five already-written child primers and adds our ground-truth federal statistics for the combined level.

1. Overview

NAICS 6213 — "Offices of Other Health Practitioners" — is the part of the federal healthcare map that captures the offices of licensed clinicians who are not physicians and not dentists. Physicians' offices have their own group (NAICS 6211) and dentists have theirs (6212); 6213 is everyone else who runs an outpatient office: chiropractors, optometrists, therapists and counselors, physical/occupational/speech therapists and audiologists, podiatrists, and a long tail of acupuncturists, dietitians, midwives, and independent nurse practitioners.[3] It is, in short, the allied-health, behavioral-health, and paramedical tier of American outpatient care.

Taken as a whole, it is large and extraordinarily fragmented: roughly 205,000 employer offices, 1.2 million workers, and about $126 billion in annual receipts (revenue), with no single company holding even ~1% of the group.[1][2] The five children share one economic engine — small, local, labor-intensive clinician offices whose profit turns on filling a schedule and collecting payment — but they reach it from different directions: some are cash-pay and consumer-flavored, others insurance-dependent and medical; some have genuine listed operators, others none at all; some are growing fast on demographic and workforce tailwinds, others are mature.

The single most useful thing an investor can carry out of this page is the contrast across the five children (Section 2). The common thread on investability: this is a private-market group first. Public-market pure-plays exist in only two of the five children; the rest are reached indirectly or privately. Where real ownership changes hands is in practices and in the private-equity (PE) and management-services platforms rolling them up.

2. What's inside — the five children and how they differ

NAICS 6213 splits into five five-digit industries. They are unequal in size and unlike in character. The table below is the heart of this primer; sections 3–10 then treat the level as a whole. (Acronyms are defined on first use in the notes below the table and in the sections that follow.)

Notes. Shares are of the level's 2022 receipts and 2023 employer establishments. "BLS" = U.S. Bureau of Labor Statistics; job-growth figures are its 2024–34 occupational projections.[4] "MSO" = management-services organization; "PE" = private equity — the standard way outside capital enters clinician offices without owning the clinical entity (see Section 7). The largest child is rehab (62134); the smallest by revenue is chiropractic (62131), which is nonetheless the second-largest by office count because it is the most solo-practitioner-heavy.

How to read the contrast. Three cuts matter most:

• Cash-pay vs. insurance-billed. Chiropractic and the wellness slice of "all other" (acupuncture, nutrition, massage) are the most cash-pay-flavored; rehab (62134), mental health (62133), and podiatry are the most insurance-and-Medicare-dependent; optometry is uniquely hybrid — part medical service, part eyewear retail. Cash-pay carries a discretionary/cyclical element; insurance-billed carries reimbursement-compression risk.
• Public investability is uneven. Only rehab (USPH, SEM) and mental health (LFST) offer genuine listed operators of these offices. Chiropractic offers a single micro-cap franchisor. Optometry and "all other" offer no pure-play at all — only diversified adjacencies (retailers, device makers, telehealth) for which the office model is one channel among many.
• Consolidation is at different innings. Rehab is the veteran roll-up and has already lived through a debt bust (ATI taken private in 2025; Athletico recapitalized).[8] Mental health is where PE capital is flowing now. Optometry is mid-cycle; chiropractic and podiatry are early; the wellness/telehealth pieces consolidate through franchising and national brands rather than scale.

3. Size — the level's rollup figures

Federal statistics for NAICS 6213 as a whole (our ground-truth extract). Note the reference-year split: employer establishments, employment, and payroll are 2023 County Business Patterns (CBP); firms, receipts, and concentration are the 2022 Economic Census (EC). These are different federal programs and different years — do not read 2022 receipts against 2023 payroll as a margin.

CR4/CR8/CR20/CR50 = the combined revenue share of the largest 4, 8, 20, and 50 firms. The HHI (Herfindahl-Hirschman Index) is a standard concentration gauge running from near 0 to 10,000; regulators treat anything under 1,500 as "unconcentrated." At 12.4, this group is essentially at the floor — one of the least-concentrated industry groups in the entire economy.

How the children add up. The child figures reconcile cleanly into the level, a good check on the data:

Establishments, employees, and receipts sum to the level totals essentially exactly; annual payroll sums to $58.49B against the level's $58.50B (rounding). Firm counts sum to ~164,600 against the level's 164,486 — slightly higher because a firm operating in two children is counted once at the level, which is expected.[2]

A few shape statistics for the level:

• ~$615,000 in receipts per office and ~$764,000 per firm — small-business economics, not capital-heavy enterprise.
• ~5.9 employees per office and ~$48,200 of annual payroll per employee — a labor-intensive service group. (Payroll ran ~46% of receipts across the vintage mismatch, consistent with labor being roughly half of revenue; not a true margin.)
• Revenue per worker differs sharply by child — highest in optometry and "all other" (~$136–138K, lifted by eyewear/product and ancillary sales) and lowest in mental health (~$84K), which is the purest labor-for-time service with no product or retail to sell. Rehab sits in the middle (~$92K).[1][2]

Undercount caveat — essential here. These are employer-only counts. CBP and the Economic Census exclude the self-employed and no-payroll ("nonemployer") businesses, and CBP also excludes most government employees.[1] Every child in this group is dominated by solo practitioners — a chiropractor, an optometrist, a therapist, a podiatrist, an acupuncturist working alone — who file as nonemployers and are invisible here. External cross-checks make the gap concrete: BLS counts hundreds of thousands of licensed clinicians across these professions working in all settings, many outside standalone offices (in hospitals, retail chains, schools, and physician groups) and many practicing solo with no payroll.[4] Our ground-truth file contains no nonemployer total for 6213 or its children, so we state none and invent no adjusted market size. Treat the ~205,000 offices and ~$126 billion in receipts as a floor for the employer segment — the true clinician and practice count is materially higher. No industry-wide margin, visit-volume, or payer-mix figure was supplied for this level, so none is asserted.

4. Investable universe — where value concentrates across the children

Two facts define the investable landscape of 6213, and both flow from the fragmentation above:

1. Value is scattered, not concentrated. With the four largest firms holding just 5.2% of receipts and the top 50 only 15.1%,[2] the great majority of the group sits outside any brand, in tens of thousands of independent single- and multi-clinic practices. There is no dominant national operator anywhere in the group.
2. Public access is thin and uneven across the five children — genuine in two, token in one, absent in two.

Where the listed operators actually are (tickers are identifiers, not recommendations; prices and multiples change daily):

• Outpatient rehab (62134) — the deepest public exposure. U.S. Physical Therapy (USPH) is the cleanest listed pure-play; Select Medical (SEM) offers a version blended with rehabilitation hospitals. This is also where the PE roll-up ran longest and then broke: ATI Physical Therapy was taken private in 2025 and Athletico recapitalized after over-leverage met falling reimbursement.[8]
• Mental health (62133) — one clean pure-play. LifeStance Health (LFST) is the sizeable listed operator; Talkspace (TALK) is a virtual-first name being acquired; broader behavioral-health operators and health insurers (e.g., UnitedHealth's Optum, which owns Refresh Mental Health) give partial, indirect exposure.[7]
• Chiropractic (62131) — one micro-cap. The Joint Corp. (JYNT), a cash-membership franchisor, is the only direct listed exposure — a small, thinly traded single-stock bet on royalty growth and unit expansion.[5]
• Optometry (62132) — no pure-play office; adjacencies only. Public exposure runs through optical retailers that host optometrists (National Vision, EYE; Warby Parker, WRBY), the vertically integrated eyewear-and-insurance giant EssilorLuxottica (EL/ESLOY), and upstream product makers CooperCompanies (COO) and Alcon (ALC). You are mostly buying eyewear retail and product margins, with the exam as the traffic driver.[6]
• All other (62139) — no pure-play; two adjacency baskets. A consumer-telehealth basket built on employed NPs/PAs and the GLP-1 wave — Hims & Hers (HIMS), LifeMD (LFMD), Teladoc (TDOC) — and a podiatry-device basket tracking foot-and-ankle surgical volumes — Stryker (SYK), Zimmer Biomet (ZBH), Treace Medical (TMCI), wound-care Organogenesis (ORGO) — plus wellness franchisors (JYNT, XPOF).[9]

The private tier is where most real ownership sits, in every child: independent practices, PE-backed MSO platforms (MyEyeDr. and EyeCare Partners in optometry; Chiro One in chiropractic; U.S. Foot & Ankle Specialists and Upperline in podiatry; regional rehab platforms; Refresh and marketplace companies in mental health), and franchise networks. For the full company-by-company map in any child, see that child's primer.[5][6][7][8][9]

5. How the money works

The whole group runs on outpatient professional-services economics — not regulated-utility rate base, real-estate rent rolls, or manufacturing throughput. Across all five children the master equation is the same:

Revenue ≈ clinicians × completed visits × collected revenue per visit. The binding constraint is utilization — how full each clinician's schedule runs — because a skilled human hour is the input and an empty appointment slot cannot be inventoried and sold later. On top of that base sit the levers that differ by child:

• Payer mix. Insurance-billed children (rehab, mental health, podiatry) are capped by fee schedules and coverage rules; cash-pay-flavored activity (chiropractic, wellness) prices freely but is discretionary. Optometry is the hybrid: professional exam fees plus a retail eyewear book that carries much of the margin.
• Product / ancillary tail. Optometry (glasses and contacts), podiatry (orthotics, braces, wound biologics), and chiropractic/wellness (memberships) can layer product and subscription revenue on top of the visit; pure-service children like mental health cannot — which is why mental health shows the lowest revenue per worker in the group.[2]

Cost structure is dominated by clinician labor — commonly 50–70% of revenue depending on the child — then rent, front-desk and billing staff, malpractice insurance, software (electronic health records), and marketing. Capital intensity is low, which keeps barriers to entry low and moats local. Three owner lenses recur across the group: the independent practice (normalized owner cash flow), the franchisor (a royalty stream on system sales), and the PE roll-up (operating improvement plus multiple arbitrage — buying single clinics cheaply and folding them into a higher-valued platform). The federal file publishes no practice-level margin, utilization, or payer-mix figures for 6213, so any such numbers in the child primers come from trade sources and are flagged as estimates.[5][6][7][8][9]

6. Demand drivers

Demand across 6213 is demographic and clinical, which makes it steadier than the broad economy — with a discretionary overlay on the cash-pay pieces. The shared drivers:

• Aging population. The U.S. 65-and-older population reached about 61 million (18% of the total) in 2024, and older adults now outnumber children.[9] More age means more joint replacements, falls, stroke, hearing loss, foot problems, eye disease, and chronic-care needs — the core tailwind for rehab, podiatry, optometry, and audiology.
• Chronic disease. Diabetes (~38 million Americans) and the fact that most adults report at least one chronic condition widen the role of every non-physician practitioner here — from diabetic foot care to nutrition counseling.[9]
• The non-drug / opioid-alternative shift. Federal pain guidance favoring conservative, non-opioid care benefits chiropractic and rehab directly.[5]
• Behavioral-health demand outrunning supply. Falling stigma, insurance parity, and telehealth normalization have pushed mental-health demand far past the supply of licensed clinicians — the strongest structural demand story in the group.[7]
• Scope-of-practice and independence expansion. As more states let optometrists deliver medical eye care and let nurse practitioners practice independently, more billable services and more independent offices come into existence.[6][9]
• Wellness and consumer spending. Cash-pay acupuncture, nutrition, and membership services ride discretionary spending — higher-margin but more budget-sensitive than medically necessary care.

The binding constraint everywhere is clinician supply. Occupational-growth projections are healthy to strong across the group (roughly 8–17% for the 2024–34 decade depending on profession), but that same scarcity means demand can convert into higher wages rather than higher profit for owners.[4]

7. Regulation

Regulation in 6213 runs profession-by-profession and state-by-state, so it is unusually fragmented — but several themes cut across the whole group:

• State licensure and scope of practice. Every profession here is state-licensed (not federally), and scope varies widely by state — what an optometrist may treat, whether a nurse practitioner may practice independently, what a chiropractor may bill. Scope is the single most important regulatory variable because it determines what an office can charge for.[5][6][9]
• Medicare and Medicaid coverage and payment. The Centers for Medicare & Medicaid Services (CMS) set coverage rules and fee schedules that move revenue directly — narrow chiropractic coverage (manual spinal manipulation only), the rehab conversion-factor cuts and therapy thresholds, the 85% payment rate for NP/PA-furnished services, and limited coverage of optometry, acupuncture, and nutrition therapy.[5][8][9]
• Corporate Practice of Medicine (CPOM) and the MSO structure. Many states restrict non-clinician ownership of a clinical practice. This is why outside capital enters every child through a management-services organization (MSO) paired with a clinician-owned professional corporation (PC): investors own the management company; licensed clinicians own the practice. It is a rising area of state legislative and antitrust attention.[7][9]
• Consumer, privacy, and channel rules. HIPAA (the Health Insurance Portability and Accountability Act) governs patient data across all these offices; the FTC (Federal Trade Commission) Franchise Rule governs the franchise route and its prescription-release rules (the Eyeglass and Contact Lens Rules) let optometry patients buy eyewear elsewhere; the No Surprises Act requires good-faith estimates for self-pay patients; and telehealth compacts plus FDA policy govern the virtual-care and product-dispensing pieces.[6][7][9]

Investors should treat licensure and ownership structure as transaction-level diligence, not boilerplate — the legal structure varies by profession and by state and is often the difference between a compliant deal and an unwind.

8. Consolidation

By the federal numbers, NAICS 6213 is one of the least-concentrated industry groups in the economy: CR4 of 5.2% and an HHI of 12.4 — effectively the floor.[2] It is a cottage industry of small practices. That fragmentation is the entire thesis for consolidators, who have applied the same playbook (professionalize billing, purchasing, marketing, and back office across many small offices) that already reshaped dentistry, dermatology, and gastroenterology.

But the group average hides very different innings by child:

• Rehab (62134) is the veteran and a cautionary tale: two decades of debt-funded roll-up, then a sharp cooling as higher interest rates, Medicare cuts, and wage inflation hit at once (ATI taken private in 2025; Athletico recapitalized in 2026).[8]
• Mental health (62133) is where PE capital is flowing now — industry trackers cite well over $20 billion deployed into behavioral health across recent years — alongside a capital-light therapist-marketplace alternative and insurer vertical integration.[7]
• Optometry (62132) is mid-cycle, contested three ways among national optical retailers, MSO/PE platforms, and surviving independents.[6]
• Chiropractic (62131) and podiatry (within 62139) are early — coherent roll-ups underway but only ~15–20% of chiropractic is "corporately aligned," and podiatry is still called an "under-tracked" segment by acquirers.[5][9]
• The wellness/telehealth pieces (within 62139) consolidate through national franchises and telehealth brands rather than through scale acquisition of physical offices.[9]

Two things are true group-wide: value creation comes from operational improvement, not national market power (barriers to entry are low and moats are local), and regulatory scrutiny is rising — a cross-government inquiry (FTC, DOJ, HHS) into corporate/PE ownership of healthcare providers and a 2025 GAO report on physician-practice consolidation put roll-ups on regulators' radar.[7][9]

9. Risks

The group shares a common risk profile, with a different emphasis in each child:

• Reimbursement compression. Medicare fee-schedule cuts, narrowed networks, and tighter coverage decisions squeeze the insurance-billed book — the rehab conversion-factor cuts, the 85% NP/PA rate, narrow chiropractic and optometry coverage.[5][8][9] Commercial payers often follow Medicare down.
• Labor is the product. Clinician scarcity, wage inflation, vacancy time, and burnout cap both capacity and margin. Strong demand can turn into higher pay rather than higher profit.[4]
• CPOM / ownership regulatory risk. State corporate-practice rules and rising antitrust scrutiny can limit or invalidate PE ownership, MSO control, or fee arrangements in any child.[7][9]
• Low barriers, weak moats, local competition. Easy entry means persistent competition; low national concentration can conceal a dominant local operator or payer network.
• Roll-up leverage and integration risk. The model relies on debt; over-levered consolidators face distress when rates rise and reimbursement falls together — rehab's ATI and Athletico are the visible scars, and a warning for the children now consolidating.[8]
• Discretionary / cyclical exposure on the cash-pay pieces (chiropractic wellness, acupuncture, nutrition, premium eyewear), which are deferrable in a downturn.
• Data / undercount risk. The heavy nonemployer tail means public statistics are an incomplete map; diligence must be built bottom-up, one local market at a time.[1]

Data limitation for this level: our ground-truth file provides no per-practice margin, payer mix, utilization, visit volume, or nonemployer receipts for 6213, so none are asserted here.

10. How to invest & outlook

Public route — narrow and uneven. Genuine listed operators of these offices exist in only two of the five children: outpatient rehab (USPH, SEM) and mental health (LFST, plus TALK being acquired). Chiropractic offers a single micro-cap franchisor (JYNT). Optometry and "all other" offer no pure-play — only diversified adjacencies (optical retailers and eyewear/contact-lens makers for optometry; telehealth, foot-and-ankle devices, and wellness franchises for "all other") for which the office model is one channel among many, and which are diluted by non-office lines. There is no dedicated exchange-traded fund (ETF) for this group. Judge each adjacency on its own drivers — retail execution, device volumes, telehealth regulation, subscriber economics — not as a proxy for the underlying offices.[5][6][7][8][9]

Private route — where most exposure lives. Owning 6213 means owning practices: buy or build a single practice, back or co-invest in an MSO/PE platform, buy a franchise, or provide the real estate, equipment, and acquisition financing around them. In every child, underwrite the local unit economics first — normalized owner cash flow (not headline revenue), same-clinic collections and visit trends, payer contracts and denial rates, clinician retention and succession, referral concentration, ancillary/membership economics, and the MSO/management-agreement terms and physician-control provisions that make a deal compliant. A platform's advertised location count matters far less than organic collections, clinician productivity, and cash conversion.

Outlook. The demand backdrop across 6213 is as durable as any in health services — an aging, chronically ill, screen-heavy, mental-health-seeking population needs more of exactly this care — and it is structurally supply-constrained, which supports pricing for operators who can staff. But this is a low-margin, labor-bound, deeply fragmented group that will stay fragmented for years, where winners are decided by unglamorous capabilities: recruiting and keeping clinicians, negotiating payer economics, and running compliant billing at scale. The most investable structural story is less "healthcare demand" (steady but not explosive) than the professionalization and roll-up of a still-fragmented cottage industry — a private-market thesis first, with a handful of narrow public proxies. And rehab's leverage bust is the standing warning that this is a story about operating discipline, not financial engineering. For the complete treatment of any single child — scope, ownership mix, the full investable roster, per-visit economics, the detailed regulatory map, and consolidation history — read that child's primer.

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Sources

Section 3 figures for NAICS 6213 are from our ingested federal ground-truth extract (stats-6213.md), drawn from the U.S. Census Bureau's 2023 County Business Patterns (establishments, employment, payroll) and 2022 Economic Census (firms, receipts, concentration, HHI). All other citations point to the sources compiled in the five child primers, which this rollup synthesizes.

1. U.S. Census Bureau, County Business Patterns, 2023 — NAICS 6213 and its five children (establishments, employment, annual and Q1 payroll; employer-only coverage, nonemployers and most government workers excluded). https://www.census.gov/programs-surveys/cbp.html
2. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 6213 and children (firms, receipts, CR4/CR8/CR20/CR50, HHI). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
3. U.S. Census Bureau, 2022 NAICS — 6213 Offices of Other Health Practitioners (definition, scope, and its position within subsector 621 Ambulatory Health Care Services). https://www.census.gov/naics/?year=2022
4. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook — Chiropractors, Optometrists, Mental-Health Counselors & Marriage-and-Family Therapists, Physical/Occupational/Speech Therapists & Audiologists, and Podiatrists (2024 employment and 2024–34 projected growth). https://www.bls.gov/ooh/healthcare/
5. Histometrics child primer, NAICS 62131 Offices of Chiropractors (and its child 621310), synthesizing SEC filings of The Joint Corp. (JYNT), CMS chiropractic coverage, NCCIH utilization data, and chiropractic-consolidation trade sources.
6. Histometrics child primer, NAICS 62132 Offices of Optometrists (and its child 621320), synthesizing FTC prescription-release rules, eye-care PE M&A benchmarks, and the eyewear public adjacencies (EYE, WRBY, EL/ESLOY, COO, ALC).
7. Histometrics child primer, NAICS 62133 Offices of Mental Health Practitioners (except Physicians) (and its child 621330), synthesizing LifeStance (LFST) filings, HRSA workforce-shortage data, MHPAEA parity rules, and behavioral-health PE trackers (Capstone Partners).
8. Histometrics child primer, NAICS 62134 Offices of Physical, Occupational and Speech Therapists, and Audiologists (and its child 621340), synthesizing U.S. Physical Therapy (USPH) and Select Medical (SEM) filings, CMS therapy-payment rules, and PT M&A/valuation sources (ATI, Athletico).
9. Histometrics child primer, NAICS 62139 Offices of All Other Health Practitioners (children 621391 podiatrists and 621399 all other miscellaneous), synthesizing BLS podiatry data, AANP full-practice-authority tracking, CMS NP/PA payment rules, foot/ankle device filings (SYK, ZBH, TMCI, ORGO), telehealth filings (HIMS, LFMD, TDOC), and the FTC/DOJ/HHS cross-government inquiry and GAO consolidation report.