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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

  • Take advantage of Internet-based PECOS to complete your enrollment application
  • PECOS submission, either e-sign or upload (PDF or TIFF) the signed and dated certification statements
  • Paper submission, ensure the application is signed and dated by an authorized/delegated official
  • Ensure that your application is complete and all supporting documentation is included
  • Be sure to pay the application fee or submit a hardship request, if applicable
  • If you are mailing in your application, verify that you are using the correct version of the CMS-855A and/or CMS-588
  • Ensure that the Legal Business Name entered matches the name located on your IRS tax document
  • Respond quickly to any request for additional information or changes required to process your application

Revised 4/15/2021

Last Modified: 6/21/21

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Mailing Address for states AK, AZ, CA, HI, ID, MI, MN, NJ, NV, NY, OR, WA, WI, & U.S. Territories:

National Government Services, Inc.

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

Mailing Address for states CT, MA, ME, NH, RI, VT:

National Government Services, Inc.

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

Contact Enrollment:


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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