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Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
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This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
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Last Modified: 5/10/2022 Location: FL, PR, USVI Business: Part A, Part B

Eliminate the guesswork

The enrollment application assistance tool removes the guesswork for providers trying to figure out which enrollment form to use, whether they are submitting an initial enrollment, a change of information, revalidation or even terminating their Medicare enrollment.
This tool offers tips to clarify what should be included in each relevant section of the appropriate enrollment form as well as what additional documentation is needed to complete the process.

Provider/supplier enrollment applications

New enrollment, change of address, or update other enrollment information

New provider enrollment, address changes, and provider file updates (e.g., practice name or change of ownership) must be submitted on the proper CMS form 855, depending on the type of provider/supplier, or through internet-based Provider Enrollment, Chain and Ownership System (PECOS). If you are submitting your information on paper, select the proper form below, based on provider/supplier type. If you are changing, adding, or deleting information, check the applicable box in each section, furnish the effective date and complete the appropriate fields in each section.

Internet-based PECOS

Find information about CMS’ online enrollment process, the internet-based Provider Enrollment, Chain and Ownership System external link (PECOS). If you are familiar with internet-based PECOS, click here external link to log in. Internet-based PECOS is the preferred method for submitting initial applications or making changes to your enrollment information.
For assistance with changing information online through internet-based PECOS, view the following tutorials hosted by CMS:

Paper enrollment applications

Medicare provider/supplier enrollment applications (i.e., CMS-855) may be found at external link (Note: This does not directly link to each individual form. Search within the table to access the desired form).
The direct link for each Medicare provider/supplier enrollment application is shown below:
CMS 855B for Clinics/Group practices and Certain Other Suppliers: external pdf file
CMS 855I for Physicians and Non-Physician Practitioners: external pdf file
CMS 855R for Reassignment of Medicare Benefits: external pdf file
CMS 855O for Eligible Ordering and Referring Physicians and Non-physician Practitioners external pdf file
CMS 855S for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers: external pdf file. Note: CGS Medicare external link is the DMEPOS Medicare Administrative Contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.
Not sure which CMS-855 form to complete? Determine your application type.

Where to submit your applications

Internet-based PECOS external link - the fastest and recommended method for application submission.
Provider Enrollment Gateway – use this tool to upload enrollment applications and check status of your submissions.
Mail completed paper provider/supplier enrollment applications to:
Provider Enrollment
P.O. Box 3409
Mechanicsburg, PA 17055-1849
Provider enrollment feedback
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.