- Determine if you will use PECOS or paper to enroll
- Enroll Using PECOS
-
Enroll Using Paper
- Determine your Business Structure
- Individual (Group Member) Reassigning Benefits Only
- Individual Medicare Enrollment Private Practice (Sole Proprietor) via SSN
- Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN
- Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID
- Physician Assistant
- New Provider Corporation or Group (Multiple Owners)
- Ordering/Referring Provider Only
- Adding a New Reassignment of Benefits Using the CMS-855I
- Electronic Funds Transfer Agreement
- Medicare Participating Physician or Supplier Agreement
- Supporting Documents
Verify and Manage Signature(s)
Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS.
Important: The reassignments are viewed by selecting “View/Manage Reassignments” in the enrollment box.
When the “Manage Signature” button appears, select to follow up if the signature status is pending. (Either resend the email to signer for e-signature or upload a (PDF, TIFF) signed and dated certification statement) Printable Certification statements are located by selecting the “View” button.
We recommend signatures being completed the same day of submission to prevent delay in processing.
View of the enrollment box with the Manage Signature button, not all inclusive:
View of the pending reassignment applications after selecting “View/Manage Reassignment” from the enrollment box with the Manage Signature button, not all inclusive:
Reviewed 6/13/2024
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
J6 Mailing Address:
National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475
Interactive Voice Response:
877-908-9499
Contact Enrollment:
877-908-8476
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. CT
Form(s) you'll need:
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee
JK Mailing Address:
National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46207-7149
Interactive Voice Response:
877-869-6504
Contact Enrollment:
888-379-3807
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. ET
Form(s) you'll need:
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
J6 Mailing Address:
National Government Services, Inc.
P.O. Box 6474
Indianapolis, IN 46206-6474
Contact Enrollment:
855-834-5596
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. CT
9:00 a.m.–5:00 p.m. ET
*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
11:00 a.m.-3:00 p.m. CT
Form(s) you'll need:
CMS-855A - Medicare Enrollment Application form for Institutional Providers
CMS-588 - Electronic Funds Transfer (EFT) Authorization Agreement form
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee
JK Mailing Address:
National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46206-7149
Contact Enrollment:
855-593-8047
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. ET
*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
Form(s) you'll need:
CMS-855A - Medicare Enrollment Application form for Institutional Providers
CMS-588 - Electronic Funds Transfer (EFT) Authorization Agreement form