Step 1: Determine You are in the Right Place

If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within 30 days of the effective date of the change by submitting an initial application with the new Tax ID.

Note: Your organization's CCN/PTAN will remain the same.

Step 2: Complete the Medicare Application

You can complete the enrollment application either electronically via Provider Enrollment Chain & Ownership System (PECOS) or on paper. Submitting the application electronically will result in a faster response than submitting by mail.

• To submit your application electronically, you will access PECOS. Here you will be able to become a registered user and gain access to the enrollment record to complete the electronic application. Select the My Associates button then select the "Create Initial Enrollment Application" button and the system will guide you through the process.
• To submit your application by mail, you will fill out CMS-855A as a new enrollee and CMS-588 (instructions for completion are on the forms). When completed, mail provider enrollment applications and supporting documents to appropriate jurisdiction and area address.
  • MAC Contact List

Note: Read Understanding Authorized Official and Delegated Official Roles.

Step 3: Submit Required Documentation

It is imperative that you submit the proper documentation along with your enrollment application regarding your change to Tax ID. Whether you chose to file electronically or on paper, you must prepare and submit documentation as follows:

• Online via PECOS: PECOS will generate a list of required supporting documentation that you can upload (PDF or TIFF) prior to submitting the application.
• Paper Form CMS-855A: See section 17 of the CMS-855A application to determine the required documentation.

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• Medicare Provider-Supplier Enrollment
• MLN Educational Tool® Medicare Provider Enrollment
• Tips to Facilitate the Medicare Enrollment Process