An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector.The service, Amazon Care, launched a year ago as an app providing on-demand chat and video consultations with medical professionals for Amazon's then-54,000 Puget Sound employees. Users can also book in-person visits at their home or office with clinicians. Payment for the service routes through Amazon.com.

In recent weeks Amazon Care has incorporated in Alaska, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Maine, Maryland, Montana, New Hampshire, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont and Wyoming, according to records filed with state agencies. The online health magazine Stat was first to report Amazon Care's expansion.

Amazon did not respond to questions about whether access to the newly expanded service will continue to be limited to Amazon employees.

But there are indications that Amazon may begin offering the service to a broader audience. In December, Business Insider reported that Amazon had pitched other companies, including Seattle-based Zillow, on the health care app. Amazon has been hiring health care practitioners, research scientists and product managers for the app around the country—including in California, Georgia and Texas, according to Stat.

And with a nationwide group of home health care providers, Amazon Care on Wednesday announced it would begin lobbying lawmakers to ease regulations on what kind of health services can be performed outside of a doctor's office—potentially widening the services Amazon Care can provide.

Amazon has not yet received professional licenses that would allow it to operate facilities like medical testing labs in the 21 states it has filed to do business. However, that paperwork may be coming down the line: In its Georgia business registration, Amazon indicated it planned to start doing business in the state this July.

Amazon began nosing around the lucrative field of health care in 2017, when it made several high-profile hires from the sector. Former One Medical Vice President Christine Henningsgaard joined Amazon, as did Missy Krasner, from the digital health-records management company Box.Henningsgaard, who left Amazon in 2019 to start the maternity-focused health care venture Quilted Health, refers to herself on her LinkedIn profile as part of the "founding team" of Amazon Care, which she described as "bringing customer obsession, advanced technology, and last mile logistics to health care."

Around the same time, the company formed an ill-starred health care consortium with Berkshire Hathaway and JPMorgan Chase. The organization, later dubbed Haven, had a stated goal of offering better service and rates from health care providers on behalf of the triumvirate's nearly 1.2 million employees; Haven dissolved last month.

Amazon purchased online drugstore Pillpack for $753 million in mid-2018; the next year, the company won landmark approval allowing its voice-activated artificial intelligence, Alexa, to transmit private patient information. When the coronavirus began infecting Amazon's hundreds of thousands of warehouse workers last summer, the company built hundreds of its own on-site laboratories to test employees.

In November, Amazon launched an online pharmaceutical delivery service, sending drugstore share prices tumbling. Just weeks later, Amazon's cloud-computing division unveiled a health data management service for doctors and hospitals that complies with patient confidentiality regulations.

Amazon Care has likely been in the works since at least early 2018, when Amazon hired Seattle geriatrician Dr. Martin Levine. Amazon Care clinicians are employed by Care Medical, formerly Oasis Medical, a company Levine founded shortly after he joined Amazon, according to business records.

Amazon replaced Levine early last year with Dr. Sunita Mishra, a former executive at Providence St. Joseph, where she led the development of the health system's mobile app for on-demand medical care. Levine is now chief medical officer at The Polyclinic health system, which operates 14 sites around the Puget Sound region. Weeks after Mishra joined Amazon, the company expanded access to Amazon Care to all of its now-80,000 Washington state workers.