Background Hospital certification and recognition programs represent 2 independent but commonly used systems to distinguish hospitals, yet they have not been directly compared. This study assessed acute ischemic stroke quality of care measure conformity by hospitals receiving Primary Stroke Center ( PSC ) certification and those receiving the American Heart Association's Get With The Guidelines‐Stroke (GWTG‐Stroke) Performance Achievement Award (PAA) recognition. Methods and Results The patient and hospital characteristics as well as performance/quality measures for acute ischemic stroke from 1356 hospitals participating in the GWTG‐Stroke Program 2010–2012 were compared. Hospitals were classified as PAA +/ PSC + (hospitals n=410, patients n=169 302), PAA +/ PSC − (n=415, n=129 454), PAA −/ PSC + (n=88, n=26 386), and PAA −/ PSC − (n=443, n=75 565). A comprehensive set of stroke measures were compared with adjustment for patient and hospital characteristics. Patient characteristics were similar by PAA and PSC status but PAA −/ PSC − hospitals were more likely to be smaller and nonteaching. Measure conformity was highest for PAA +/ PSC + and PAA +/ PSC − hospitals, intermediate for PAA −/ PSC + hospitals, and lowest for PAA −/ PSC − hospitals (all‐or‐none care measure 91.2%, 91.2%, 84.3%, and 76.9%, respectively). After adjustment for patient and hospital characteristics, PAA +/ PSC +, PAA +/ PSC −, and PAA −/ PSC + hospitals had 3.15 (95% CIs 2.86 to 3.47); 3.23 (2.93 to 3.56) and 1.72 (1.47 to 2.00), higher odds for providing all indicated stroke performance measures to patients compared with PAA −/ PSC − hospitals. Conclusions While both PSC certification and GWTG ‐Stroke PAA recognition identified hospitals providing higher conformity with care measures for patients hospitalized with acute ischemic stroke, PAA recognition was a more robust identifier of hospitals with better performance.