The Nitra Founding Story

Today we’re announcing that Nitra has raised $187 million in funding as we build the AI operating system for healthcare practices. In the past year, transaction volume on Nitra has grown 740%+, surpassing $1 billion in annualized processing across 700+ practices and 2,500+ physicians. 

We also announced that Dr. Richard Park, the founder of CityMD, one of the largest urgent care groups in the country, will be joining the Board of Nitra.

Most software in healthcare was built to document care, diagnose care, bill for care, or store records about care. Very little was built to run the business of care. Yet every day, physicians and their staff are buried in the operational work required to keep a practice alive: scheduling patients, verifying eligibility, ordering drugs and supplies, paying vendors, reconciling accounts, managing staff, and trying to make dozens of disconnected systems work together. 

We started Nitra because we believed the business of healthcare needed its own modern operating system. Healthcare has some of the most advanced clinical technology in the world but some of the most fragmented business infrastructure of any major industry. We’re building the AI infrastructure for the business of healthcare.
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The United States of Healthcare

Roll back the clock to 2022. The world just emerged from a devastating pandemic and for the last two years the entire country watched from their homes as images of patients, healthcare workers, and hospitals played on repeat. We all felt the struggle to obtain PPEs, medical equipment, and vaccines in record time, and as the world emerged and returned to normal, we collectively said: never again.

Despite our past, healthcare has continued to exponentially increase in size, expense, and complexity. This year in 2026, Americans will spend an estimated $5.9 trillion on US Healthcare. That amount is so staggering that if the American healthcare industry were a country by itself, it would be the third largest country by GDP ranking ahead of Germany, Japan, and India.

American healthcare itself is sick. It is the largest employer in the country and for many families their largest expense, yet many practices still run on fragmented administrative infrastructure.

The modern doctor sits at the epicenter of a complex web of administrative and financial tasks that collectively drain healthcare services from our country and the business of healthcare, buying pharmaceuticals, paying for surgeries, and securing care for the elderly or for patients with rare diseases, remains as dull and complex as ever.
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Our Journey

Jonathan and I met in elementary school and have been building things together ever since. I started my career in politics and I still remember the endless debates in college at Princeton about the Affordable Care Act and the tremendous passion it ignited in everyday Americans.

After college, Jonathan and I decided to start our first company together, FiscalNote, building vertical SaaS for lawyers and government agencies. Over time, the company grew to more than 5,000+ customers and a global team of over 900 people. Building the company taught us how to scale quickly and gave us exposure to a wide range of regulated industries. Healthcare, broadly defined, represented roughly a quarter of our customers and we got front row seats to state by state reimbursement tables and FDA regulatory guidelines.

Building FiscalNote taught us how difficult it is to modernize regulated industries and how valuable software becomes once it is embedded in critical workflows. Healthcare stood out to us because of both its scale and its fragmentation. It was one of the few sectors where the operational pain was obvious, the spend was massive, and the underlying infrastructure still felt years behind where it should have been.

We never could have imagined the pandemic and the impact it would have on all our lives. In 2021 as we were still under large social distancing rules, Jonathan and I began taking long walks from Crystal City in Virginia through the National Mall in Washington. During these four hour walks, we discussed how the healthcare system could be reformed and gradually felt compelled to tackle the problem ourselves. We decided to build Nitra.
 

Nitra

Nitra’s origin starts with a core problem physicians face: they do not have full control over how their practices operate. 

Imagine a prominent plastic surgeon like Dr. Rosenthal who runs a busy and thriving practice in Palm Beach, Florida. For Dr. Rosenthal, the job isn’t just delivering care to the thousands of patients that come through his door every year. 

He is hiring and managing staff, scheduling patients, processing insurance claims, purchasing supplies amidst price and availability uncertainty, paying vendors, managing expenses, reconciling accounts, and making constant decisions about cash flow and inventory. Each of these functions matters and each can create friction for the people trying to deliver care. 

There are over 500,000+ clinics and practices like Dr. Rosenthal delivering on the front lines. Yet most practices are still managing these tasks through disconnected systems. They may use one vendor for banking, another for expense controls, another for payroll, another for procurement, another for patient intake, and another for accounting. The connective tissue between them is a person manually entering information, reconciling records, or chasing down mistakes. 

Consider a retina clinic, dermatology practice, or surgical center processing millions of dollars a year in payments, drug purchases, payroll, and operating expenses. The physician may be delivering care, but behind the scenes the practice is still stitched together through spreadsheets, phone calls, paper invoices, fragmented software, and manual reconciliation. 

A missed supply order can delay a procedure. A delay in eligibility checks can frustrate a patient. A coding or accounting error can create downstream financial stress. These inefficiencies show up in patient experience, staff burnout, and the economics of care delivery.

Now think about the typical patient experience. A patient waits on hold to schedule an appointment, fills out paper forms at check-in, waits for insurance eligibility to be verified, and may even have a procedure delayed because inventory was not ordered in time. Weeks later, the reimbursement arrives and someone at the practice has to reconcile it manually. The operational failures behind the scenes show up directly in patient experience.

Why doesn’t it just work? Why can’t software orchestrate the scheduling to insurance eligibility to inventory purchasing to banking and expense reconciliation? Why can’t independent practices like Dr. Rosenthal have access to the same level of operational intelligence that large hospital systems do? 

The current processes and systems are expensive, slow, and error-prone. It also creates real human costs. Administrative drag does not just reduce efficiency. It contributes to burnout, distracts staff, and degrades the patient experience.

While healthcare has been large and inefficient for a long time, three things have recently made this moment different:

First, the economics of the back office have become impossible to ignore. Rising labor costs, severe staffing shortages, reimbursement pressure, supply chain volatility, tariffs, and procurement complexity have made operational efficiency far more urgent for practices already under strain.

Second, the underlying infrastructure is finally mature enough to support a more unified product. Modern payments infrastructure, embedded finance, better APIs, cloud software, and workflow automation make it possible to consolidate what previously required multiple vendors and large amounts of manual effort.

Third, AI expands what software can do inside the workflow. Historically, software mostly recorded work after humans completed it. Increasingly, software can perform pieces of the work itself: categorizing expenses, routing invoices, checking eligibility, managing communications, recommending reorders, reconciling records, and coordinating across systems. In a sector where enormous amounts of labor are still spent on repetitive coordination, that matters.

Separately, AI for clinical decision support has been all the rage in the healthcare industry and Silicon Valley. While we believe that is a large opportunity, we believe the larger opportunity is delivering real and lasting AI capabilities to the business of healthcare.
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Our Approach

With all this, Nitra's mission is to build a more efficient healthcare system and the technology that makes it possible.

Most healthcare software addresses only one function: records, claims, scheduling, payroll, payments, procurement, or analytics. Very few are designed to connect the entire operating layer of a practice. Most software in healthcare still focuses on documentation and billing rather than operations.

We approached the problem differently. We started with the financial rails of a practice: how money comes in, how money goes out, how purchases are made, how expenses are controlled, and how transactions are reconciled. 

From there, we began building outward into the rest of the operational workflow: bill pay, accounting, inventory, procurement, scheduling, patient communications, and, increasingly, AI agents that can automate more of the administrative burden directly.

Financial products create the initial wedge. Software increases engagement and retention. AI turns the system from a passive platform into an active operator on behalf of the clinic. This is not just a fintech business, and it is not just vertical software. It is an attempt to build the system that coordinates how healthcare practices actually function day to day.

We anticipated that the marginal revenue derived from AI agents and software would drop by an order of magnitude and required a bundled monetization layer that would allow healthcare practices to get rapidly onboarded with minimal friction without sacrificing monetization potential. In other words, in a universe of unlimited voice AI and low cost software, the natural approach was to bundle embedded fintech into the best software we can deliver to customers. 

Health spend is both recurring and operationally central. They do these things constantly. That creates frequent product engagement and opportunities for deeper embedding.

We are building the operating system for healthcare practices. The long-term goal is to become the infrastructure layer that sits between clinics, suppliers, distributors, patients, insurers, and eventually pharmaceutical and device manufacturers. 

As more workflows move onto the platform, the system becomes more embedded in each practice’s operations. As more transactions move through Nitra, the company gains richer data, stronger automation, and more ways to improve outcomes for customers. The result is a compounding product advantage built on trust, data, workflow ownership, and network effects.
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Building the Platform

Nitra is building an all-in-one platform that brings together finance, software, and AI for healthcare practices. At the foundation are the core financial rails: cards, payments, bill pay, expense management, and treasury-like workflows. On top of those rails, Nitra layers software for procurement, marketplace transactions, inventory, staffing, payroll, and patient-related operations. Then, increasingly, it adds AI to automate and coordinate these workflows across the system.
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Finance and Operations

Nitra is building the AI-native operating system for healthcare finance and operations. The company’s belief is simple: healthcare practices do not need another narrow tool. They need a system that helps run the business behind care. 

They need modern infrastructure for payments, procurement, payroll, scheduling, expense management, patient operations, and financial workflows. They need software that does not merely record work after the fact, but actively helps automate and improve how the practice runs. 

We started by looking at every financial flow that exists within a practice, every way a practice receives money and every way they spend it, and built software and automation to drive a cohesive understanding of what to build. 

This gave us a clear roadmap. We could begin with the financial system of record for the practice, then layer on the surrounding software and workflows that determine how the business actually runs. Over time, that means moving from cards and expense management into bill pay, accounting, procurement, payroll, scheduling, patient operations, and workflow automation. 

We spent more than a year in closed beta, building the product, securing banking partners, and obtaining regulatory licenses before publicly launching in February 2024. We launched with a core offering in practice expense and corporate cards, then expanded into expense management, inventory management, equipment lending, accounting, bill pay, and a broader set of software and AI tools purpose-built for healthcare practices.

From there, we expanded outward, layering software onto each financial workflow to drive deeper adoption, retention, and engagement. We then layered AI agents across the platform to enable smarter decision making, workflow automation, and operational insight.

Our long term goal is to deploy fully autonomous agents that can handle complex administrative tasks, from checking in patients to reordering inventory to reconciling insurance claims, continuously in the background of a practice.

Today, our customers depend on Nitra to manage complex financial workflows and handle large transactions that deliver mission critical drugs and surgical equipment for practices. 

To date, we have helped 700+ practices and 2,500+ physicians save time and money within their practices. In certain specialties including dermatology and plastic surgery, we’ve grown to become the largest and fastest growing player in those practice areas. 
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Commerce and Procurement

We took a look at our purchase data within our cards and expense management systems and found some interesting patterns - physicians have exacting preferences on vendors, pharmaceuticals, and equipment. 

In 2025, we took steps to launch NitraRX and NitraMart in order to offer tens of thousands of SKUs in partnership with McKesson, Medline, and dozens of other vendors. As part of this process, Nitra also obtained specialty pharma licenses to directly distribute biopharmaceuticals to our customers, allowing Nitra the direct opportunity to enter the $1.2 Trillion biopharma market and the $600 Billion medical device market. 

Nitra has partnered with dozens of biopharma manufacturers and distributors to offer everything from injectables, to vaccines, to hospital antibiotics and antivirals. Within months of launch, this line of business for us has already reached escape velocity on its way to high seven figures of revenue and we expect it to be in the mid eight figures by the end of this year.

Healthcare practices do not just need software. They also need reliable access to the products, pharmaceuticals, and equipment required to deliver care. If a platform is already helping a clinic manage payments, expenses, and operational workflows, it is in a strong position to improve how that clinic purchases as well. 

This is important for three reasons. First, procurement is one of the largest and most operationally painful parts of running many practices, especially in specialties where drugs, devices, and procedure-linked supplies represent major spend categories. 

Second, procurement data is highly informative. It tells us what practices buy, in what quantity, at what cadence, from which suppliers, and in response to which patient and procedural needs.

Third, for Nitra, it allows us a clean pathway to increase revenues and our scale even on the same transaction volume without introducing additional friction to the provider. 

Over time, that creates the foundation for a deeper supplier network, better pricing, smarter reordering, and a more intelligent marketplace embedded directly into the workflow of care delivery. 

Just imagine a world where a practice is able to anticipate supply needs from procedures, patient volume, and history - preventing shortages, overstocking, and triggering smart reorders for the best price on an automated basis. This is what embedded agentic commerce looks like in healthcare - frictionless and predictive.

This year, we are also experimenting with two expansion points to our Commerce business. First, we are looking at offering direct, relevant advertising to providers at the point of purchase with direct purchasing intent, showing better deals or alternatives to their current pharma and medical purchases. 

Second, we are partnering directly with late stage, pre-FDA approval biotech companies to offer direct distribution and integrated financing to our provider network, using our network, advanced analytics, and AI agents to create an embedded and AI-native pharma contract sales organization to support and accelerate the commercialization of some of the most promising drugs coming to market. We’ve already seen great success with device manufacturers and partners like Cartessa and distributors like Tubare in leveraging our network for greater commercial success. 

Eventually, all together this creates a fully integrated workflow and ecosystem. A Nitra voice agent can schedule a patient, the practice can order Eylea through NitraRX using the Nitra Practice Card, track usage and reorder through inventory management, and reconcile the purchase through bill pay and accounting in one system. No fumbling with finding your card; no faxed paper authorization forms, no 1800 sales rep payments, no manual entry - just one integrated system. 
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AI Agents

Imagine a practice where software automatically checks in patients, verifies insurance eligibility, orders supplies, schedules staff, and reconciles claims in the background.

This is possible because of the growing volume of proprietary operational data flowing through Nitra every day, including billions of dollars in transactions across our platform. 

These transactions represent the operational heartbeat of hundreds of medical practices. We can see when practices buy certain drugs or syringes, what brand of gloves doctors in the Southeast prefer, how often they purchase them, whether they buy in bulk or in smaller quantities, which vendors they prefer, and how those decisions affect cash flow and operations. That context makes better automation possible.

Large hospital systems operate with entire teams dedicated to finance, procurement, and operations. Independent clinics do not. Nitra changes this. The platform gives clinics access to AI-driven financial management, automated accounts payable and reconciliation, predictive inventory ordering, integrated payments and bill pay, procurement marketplaces, automated staffing and scheduling tools. In effect, Nitra gives every clinic its own AI finance team, procurement team, and operations team.  

A lot of healthcare AI companies are effectively building narrow copilots. Nitra is aiming at something larger. Because it already sits in financial and operational workflows, it can train AI systems on actual business processes: how practices purchase, how they spend, how they reconcile, how they schedule, how they staff, and how they communicate. That is a much more durable starting point than building a standalone assistant with limited context.
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Data and AI Flywheel

One of the things that makes this model powerful is that the platform improves as more workflows run through it. Every payment, invoice, purchase, reorder, staffing decision, scheduling event, and reconciliation action generates structured operational data. Over time, that gives Nitra a far more complete understanding of how practices actually function day to day. 

That matters because the future of healthcare software will not be defined only by systems of record. It will be defined by systems that can act. To automate work effectively, software needs context: what a clinic buys, how often it buys it, how claims are processed, what staffing patterns look like, what vendors it prefers, how cash moves, and where bottlenecks tend to emerge. 

The more of those workflows that run through Nitra, the better the system becomes at prediction, benchmarking, recommendation, and automation. Today, more than 50% of our original card customers leverage Nitra’s expense management and bill pay features and over 20% are active NitraRX and NitraMart customers. As we launch new capabilities, we expect to serve a greater share of our customers’ operational needs.

We believe this creates a compounding advantage. The platform becomes more useful to practices, more embedded in daily operations, and increasingly capable of running those operations autonomously.

Through finance, commerce, and AI, we are unifying the healthcare back office into a single platform and building the future infrastructure for the entire healthcare supply chain. We believe that Nitra has multiple pathways to build multiple nine figure revenue businesses to build a true platform company.

The Future with Nitra

Healthcare is the largest and most complex industry in the United States, yet much of the infrastructure that powers its daily operations remains fragmented and manual. Independent practices, which care for millions of patients, are often forced to navigate an administrative maze that drains time, capital, and energy from the people who should be focused on delivering care.

We believe the next generation of healthcare infrastructure will look very different. It will unify finance, procurement, patient operations, and administrative workflows into a single operating environment. It will use AI not only to assist people, but increasingly to perform real operational work in the background. It will give independent clinics capabilities that once existed only inside large hospital systems with much bigger teams and budgets.

That is the future we are building toward at Nitra. We believe the practices that deliver care should have the same level of operational intelligence as the companies that power the modern economy.

Nitra has assembled an elite team of veterans from Goldman Sachs, Plaid, Discord, TikTok, Meta, Outcome Health, Uber, Capsule, Square, Intuit spanning the absolute best from healthcare, finance, and AI to build the most consequential healthcare company of our time. 

While the Magic 7 gets a tremendous amount of press attention, of the top 25 companies in the Fortune 25, 9 of them are in healthcare. We believe we’re on a pathway to building an enormous and consequential company, following in the footsteps of companies like Veeva, ServiceTitan, Toast, Shopify, Rippling, Waystar, and AthenaHealth.

We are still early, but we believe the companies that define the future of healthcare will be the ones that make care delivery operationally scalable, not just clinically better documented. We work every day to serve the people that serve our communities. This year, Nitra will grow from roughly 50 people to more than 200 across our offices in New York, Washington, DC, and Taipei. 

If you are a physician interested in modernizing your practice, we would love for you to try Nitra. And if you want to help build the infrastructure that powers the future of healthcare, we are hiring. 

Nitra is building the future of healthcare.

Tim Hwang

Co-Founder and CEO

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