Last Modified: 7/1/2014 Location: FL, PR, USVI Business: Part B, Part A
Updating provider enrollment information
Q: How do I change my address or update other provider enrollment information (e.g., practice name or change of ownership)?
A: Address changes and provider file updates must be submitted on the proper Centers for Medicare & Medicaid Services (CMS) form, depending on the type of provider/supplier, or through Internet-based Provider Enrollment, Chain and Ownership System (PECOS). A CMS-855I is required for an individual, a CMS-855B is required for an organization, and a CMS-855A is required for institutional providers. For more information, refer to the Provider/supplier enrollment applications section of the First Coast Service Options Inc. (First Coast) provider website. This page provides an overview of provider-supplier enrollment, as well as links to enrollment applications.
Please use your browser's back button to return to the referring page.