Change Existing Provider Enrollment Information

Time Requirements to Notify Medicare of Changes

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)

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

Revised 4/8/2021

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

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS

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