- 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
Sign and Submit the Application(s)
In order to send your application, after resolving all errors, you must select “Begin Submission” which is available from any of the tabs (Topic View, Fast Track View, Error/Warning Check).
Instructions for signing and submitting the applications(s):
- Proceed with the electronic signature or upload certification process
- If electronic method selected:
- You will either be prompted to sign electronically or an email will be generated for the individual provider or the authorized/delegated official with instructions to electronically sign.
- If upload method selected:
- Print the hardcopy certification statement
- Obtain original signature and enter current date
- Save document as a .pdf or .tiff
- Upload the signed certification statement
Important: A certification statement should never be uploaded to the required and/or supporting documentation topic section.
- If electronic method selected:
- Read and answer attestation question when applicable.
- Select National Government Services as your contractor (Jurisdiction 6 – IL, MN and WI) (Jurisdiction K – CT, MA, ME, NH, NY, RI and VT)
- Scroll to the bottom and select “Complete Submission.”
Mail any supporting documents that were unable to be uploaded before submission, indicate the case or tracking number from acknowledgement notice.
The application percentage will then display as 100% complete and a confirmation from customerservice-donotreply@cms.hhs.gov will be sent to the email address of the contact person containing the tracking number for your application.
Note: Add the above email address to your safe senders list and routinely verify spam or junk email folders
Please share your thoughts about your experience with our enrollment process.
Revised 6/17/2024
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