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Report a Change of Information
Report a Change of Information

Report a Change of Information

Best Practices for Changing Provider Information:

  • Verify that you are using the correct version of the CMS-855 (07/11)
  • Ensure that your application is complete and that all supporting documentation is included
  • Sign and date your application
  • Respond quickly to any requests for additional information
Last Modified: 9/1/16

Check Provider Enrollment Application Status

Learn About PECOS Web!

J6 Mailing Address:

National Government Services, Inc.

P.O. Box 6474 | Indianapolis, IN 46206-6474

JK Mailing Address:

National Government Services, Inc.

P.O. Box 7149 | Indianapolis, IN 46207-7149

Contact Enrollment:

J6: 855-834-5596

JK: 855-593-8047

Available by phone Monday-Friday*
JK: 8:00 a.m.-4:00 p.m. ET
J6: 8:00 a.m.-4:00 p.m. CT
J6: 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

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