Getting a GP in Madrid: From Your NUSS to a Tarjeta Sanitaria

To get a GP in Madrid, first confirm your healthcare entitlement with Social Security, then register with Madrid’s health service at your local centro de salud. Employees and autónomos registered as working in Spain normally use the work-based route; the paid convenio especial is a separate option for people without recognised entitlement.

The NUSS is your Social Security identification number, also called an NSS or NAF. You can have one before your first job: Importass explicitly says its status report can show that someone has a NUSS but has never been de alta, or registered as working.

Record or document	What it tells you	Where to check
NUSS / NSS / NAF	Your Social Security number. The number alone does not confirm healthcare entitlement.	Importass, the Social Security records portal.
Alta as an employee or autónomo	You are registered as working under the relevant Spanish Social Security regime. A signed contract or a future start date is not proof of a current alta.	Importass current-status report; for autónomos, the registration resolution too.
Healthcare entitlement record	Whether the INSS, the national Social Security institute, recognises your right to public healthcare.	Social Security’s healthcare-rights enquiry and entitlement document.
Tarjeta sanitaria	Your individual card in Madrid’s public health service, SERMAS, used for local healthcare registration and access.	Your assigned centro de salud, or health centre.

The useful check: download the Informe de situación actual del trabajador. It distinguishes current alta, baja and never having been registered.

Then use Social Security’s healthcare information and service links to find “Asistencia Sanitaria: consulta del derecho y emisión del documento acreditativo del derecho”.

If your job has started, ask your employer or payroll contact for confirmation of your alta en la Seguridad Social and check it against the Importass report.

Once you are de alta, check the healthcare-entitlement record above. If it is recognised, the next step is the Madrid card application. Have your NUSS, identification, Madrid address-registration details and the entitlement document available. A copy of the alta confirmation is useful if there is a mismatch to resolve.

If the report says you have never been registered, or shows an unexpected baja, take that specific problem to payroll and the Social Security Treasury, TGSS. If the work registration is correct but the healthcare entitlement is missing or incorrect, the relevant recognition service is INSS.

Contract and padrón, but no NIE yet

First separate no NIE number from waiting for the physical TIE residence card. The NIE is an identifying number; the TIE is a separate document for non-EU residents. See our NIE, TIE and padrón guide.

• You have a NIE but are waiting for the TIE: use the NIE already assigned to you. Have your passport, residence decision or renewal evidence, NUSS and alta/entitlement records together so the identity and residence position can be checked.
• You genuinely have no NIE number: start with payroll/TGSS to establish whether an alta has actually been registered, under which identification details, and what must be completed or corrected. Bring your passport and existing NUSS/registration evidence to that enquiry. Importass’s standard adult NUSS application lists DNI/NIE; ask TGSS how to proceed if you have neither.

For the standard Madrid card, the published requirements include recognised INSS entitlement, regional padrón registration and, for foreign applicants, residence permission in force or being renewed. If your identification or residence record is incomplete, ask the health centre which evidence is needed for your case.

An autónomo, or self-employed person, registered in the Spanish Social Security system also has a work-based route to healthcare. The relevant work registration is RETA, the self-employed Social Security regime. Having a NUSS or only having dealt with tax registration is not your proof of RETA alta.

The practical sequence is:

1. Check the RETA registration. Download your autónomo registration resolution from Importass, and use the current-status report to check that you are still de alta.
2. Check healthcare entitlement with INSS. Use the same healthcare-rights service as an employee.
3. Register with Madrid’s health service. Have your identification/residence documents, NUSS, padrón details and entitlement document ready. Keep the RETA resolution available if the desk needs to trace the registration.

If your gestor handled the setup, ask for the resolución de alta en RETA. If there is no RETA registration, resolve that with your gestor/TGSS first. If there is an active RETA record but the healthcare-rights enquiry is wrong, follow up with INSS.

If you remain insured through another country while working remotely, check the applicable cross-border healthcare route with INSS.

Once entitlement is recognised, have these details available so staff can locate your records:

• Your identification, including the NIE where assigned, and the relevant residence or renewal evidence for your situation.
• Your NUSS and the healthcare-entitlement document, if obtained from the INSS service.
• Your current Madrid padrón details or certificate, so the address used for the application can be checked.
• For a recently registered employee or autónomo, your alta confirmation or RETA resolution if a registration mismatch needs tracing.

Madrid’s official card procedure allows some identification and residence data to be checked electronically. It says you do not need to bring the application form when applying at the health centre: the administrative unit specifies what your particular case needs. The procedure currently displays an online-application maintenance suspension and directs applicants to in-person SERMAS centres. Check the page before choosing the online route.

The card application is free. After validation, Madrid gives an approximate three-to-four-week delivery time to your assigned health centre, including for electronic applications. If you need care before the card arrives, the procedure says the health centre can facilitate access.

Recognised beneficiaries and people covered by another country under applicable European or bilateral arrangements may have a different route. The INSS healthcare guidance explains recognition and the documents used for family-beneficiary applications, including identity and family-relationship evidence.

Madrid also has a separate DASE procedure for foreign nationals living in Spain without registration or authorisation as residents, with its own conditions. The current DASE procedure is the place to check that situation.

Keep your existing cover while your entitlement and registration are being established.

The convenio especial is a paid healthcare agreement for people without recognised entitlement to the national public health system. Check it after ruling out work-based, beneficiary or cross-border entitlement.

Madrid’s published conditions include current residence and padrón registration in the region, plus at least one continuous year of effective residence immediately before applying in Spain, another EU or EEA country, Switzerland or the UK. Each family member needs a separate application.

The listed monthly contribution is €60 if you are under 65, or €157 from age 65.

Its coverage includes the national system’s core healthcare services. It excludes the supplementary outpatient benefits listed by Madrid: prescription medicines, orthoprosthetic provision, dietary products and non-urgent medical transport. Budget for those separately.

The agreement does not issue the standard tarjeta sanitaria. Madrid provides a Documento para Asistencia Sanitaria, which identifies the holder and assigned professionals and centres. Coverage is not activated merely by sending an application: follow the resolution, signing and payment instructions.

Use the current convenio application page for the document checklist. It includes historical residence evidence and a complete passport copy. If part of your qualifying year was abroad, ask the processing service how to evidence it; do not assume a recent Madrid padrón certificate proves the whole year.

Your address determines your initial local health zone. Use Madrid’s official health-centre locator and confirm the result with the centre. Keep your address and contact details updated when you move.

That initial allocation is not the same as being permanently tied to one doctor. Madrid’s libre elección sanitaria system allows a choice of family doctor, paediatrician or nurse, including at another centre, under its published conditions. You do not need to justify wanting a change, although the system provides for reasoned refusals in specified circumstances.

For an in-person change, go to the centre where the chosen professional works. Madrid describes provisional access following the request, becoming definitive after a maximum of three months without an adverse notification. Choosing a doctor elsewhere does not move every service: home visits remain with the team covering your actual address. Changing GP can also change your reference hospital; ask about that before switching.

Once your professional is assigned, use the official Cita Sanitaria page for appointment options, or ask the centre’s desk how to book with your details.

If you are still comparing systems, our public versus private healthcare guide covers the wider trade-offs. For the address-registration step, start with getting empadronado in Madrid.