- 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
Upload Supporting Documents
Instructions for PECOS to upload required supporting documentation:
- Select the ‘Topic View’ tab
- Select “Required and/or Supporting Documents”
- Upload documents
Mandatory for all provider/supplier types:
- Voided check or bank confirmation letter
- IRS document such as the IRS-CP575 or IRS-147C that displays the legal business name and TIN/EIN
Note: Providers who are reassigning all of their payments to another entity are not required to submit these forms.
Mandatory for all provider/supplier types, if applicable:
- Medical license/certification
- National certification and diploma for nonphysician practitioners
- DEA certification
- Business license
- Organizational Structure Diagram/Flowchart
- Final adverse legal action documentation
- Accreditation
- Application fee receipt or hardship exception request
- Documentation verifying IDTF supervisory physician(s) proficiency and/or state licenses or certifications for IDTF nonphysician personnel
- Documentation verifying state licenses or certifications of the laboratory director or nonphysician practitioner personnel of an independent clinical laboratory
- FAA 135 certification (air ambulance suppliers)
- Ambulance vehicle registration
- Mobile/Portable vehicle registration
- Comprehensive liability insurance policy (IDTFs only)
- Attestation for government entities and tribal organizations
- IRS confirmation of disregarded entity
- Lending relationship ‒ Statement in writing from the bank detailing agreement to waive its rights of offset for Medicare receivables
Note: If unable to upload supporting documentation, mail the documents with PECOS Web Tracking ID indicated on each page.
Related Content
- MLN Matters® SE1230: Addition of Digital Document Repository to Provider Enrollment Chain and Ownership System (PECOS)
- Digital Document Repository (DDR) How To Guide
- Supporting Documentation Required for Enrollment Revalidations
Reviewed 7/30/2024
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