Report Changes to your Enrollment Records
You must report changes of information in your Medicare enrollment records within 30 days for:
- Change(s) in ownership or control, including changes in authorized officials(s)
- Change(s) in practice location
- Final adverse legal action(s)
- IDTF supplier change(s) in general supervision
- MDPP supplier change(s) in coach roster
All other changes to your existing Medicare enrollment records must be reported within 90 days.
The request may be submitted no more than 60 days prior to the effective date of the change reported on the application.
Reminder: Terminate reassignments and employment arrangements timely.
Related Content
- MLN Matters® SE1617:Timely Reporting of Provider Enrollment Information Changes
- Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-08, Medicare Program Integrity Manual, Chapter 10
Revised 7/29/2024
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee
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: