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Jurisdiction 1 Part B
Provider Enrollment

Provider Enrollment Resources

Access CMS-855 forms then print, sign and mail to Palmetto GBA:

J1 MAC - Palmetto GBA
Provider Enrollment
P.O. Box 1508
Augusta, GA 30903-1508


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Opt Out Listing: Hawaii04/30/2013
Opt Out Listing: Nevada04/30/2013
Opt Out Listing: Northern California04/30/2013
Opt Out Listing: Southern California04/30/2013
Opt Out of Medicare Provider Enrollment: Instructions and Affidavit04/30/2013
Revalidation Initiative: Frequently Asked Questions (FAQs)04/11/2013
Mandatory Claim Submission: Physicians and Other Health Care Practitioners Not Enrolled in Medicare04/01/2013
CMS-588 Electronic Funds Transfer (EFT) Registration Form03/25/2013
Internet-Based Provider Enrollment, Chain and Ownership System (PECOS)03/25/2013
Provider Enrollment Appeals Process03/25/2013
Provider Enrollment Information03/25/2013
Providers Legally Eligible to Order and Refer: Medicare Program03/25/2013
List of Providers sent a Revalidation Request03/12/2013
Providers Opting-Out of Medicare: Private Contracting02/04/2013
Medicare Provider Enrollment Application Fee for Calendar Year (CY) 201312/12/2012
Implementation of Provider Enrollment Provisions in CMS-6028-FC12/04/2012
Addition of Digital Document Repository to Provider Enrollment Chain and Ownership System (PECOS)08/15/2012
Do You Need To Reactivate Your Medicare Number?07/01/2012
Medicare Physicians and Non-Physician Practitioners: Protecting Your Privacy, Protecting Your Medicare Enrollment Record07/01/2012
Online Medicare Enrollment: Internet-based PECOS07/01/2012
Tips for Using Internet PECOS07/01/2012
CMS-460 Medicare Participating Physician or Supplier AgreementOpen in New Window06/12/2012
Were You Sent a Request to Revalidate Your Medicare Enrollment?06/12/2012
Sign Your Medicare Enrollment Application Electronically04/30/2012
CMS-855 Applications and Internet-based PECOS03/14/2012
Enrollment Application Finder Help Tool03/14/2012
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last updated on 6/01/2013
ver 1.0.42