Last Modified: 12/23/2017 Location: FL, PR, USVI Business: Part A, Part B
Where to mail -- Provider enrollment paper applications
Did you know you can save time by enrolling online?
Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) is the preferred method for provider enrollment.
Internet-based PECOS facilitates the Medicare provider enrollment process by furnishing health care providers and suppliers with an easier, faster, and more efficient alternative to paper-based enrollment in the Medicare program. Registered users may use the system for initial enrollment as well as to change, reactivate, revalidate or voluntarily terminate an existing enrollment record. Users may also add, change, or terminate reassignment of Medicare benefits.
Learn how to enroll online with Internet-based PECOS.
Paper enrollment mailing information
If you cannot submit your information online, you may mail your completed paper application to your assigned Medicare administrative contractor (MAC). First Coast Service Options Inc. (First Coast) is the MAC assigned to Florida, Puerto Rico, and the U.S. Virgin Islands. If you are located within this jurisdiction, please mail the following forms to the address listed below:
Provider enrollment form
P.O. Box 44021
Jacksonville, FL 32231-4021
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.