- Determine if you Will Use PECOS or Paper to Revalidate
- Submit Revalidation Using PECOS
- Submit Revalidation Using Paper
- Clinics/Group Practices and Other Suppliers
- Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits
- Physicians and Nonphysician Practitioners that Reassign All Benefits
- Electronic Funds Transfer Agreement
- Supporting Documents
Paper Enrollment Process
Paper-based enrollment applications are available.
Submitting your enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features.
Determine which CMS-855 paper form you will need to complete under Enrollment Forms; download the form and proceed to the instructions specified in the form.
Note: The CMS-855R is not used for revalidation.
Please share your thoughts about your experience with our enrollment process.
Revised 11/19/2021
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: