Last Modified: 12/13/2017 Location: FL, PR, USVI Business: Part A, Part B
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.
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form for submission.
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.