Do You Need to Change Your Address on Your Provider File?

It is very important that providers update their file once a change of address is made. Incorrect information in the file could lead to your correspondence from Palmetto GBA being delivered to an incorrect address, office or building.

Address changes and provider file updates must be submitted through internet-based Provider Enrollment, Chain and Ownership System (PECOS), or on the proper Centers for Medicare & Medicaid Services (CMS) form, depending on the type of provider or supplier. 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.

Change of Address Using PECOS
Find information about the Centers for Medicare & Medicaid Services’ change of address information on Provider Enrollment Chain and Ownership System (PECOS). 

Log into Internet-based PECOS. 

Note: PECOS is the preferred method for submitting initial applications or making address changes to your provider file.

Change an Address on a Paper Enrollment Application
The direct link for each Medicare provider/supplier enrollment application is shown below:

• CMS-855A for Institutional Providers (PDF, 835 KB)
• CMS-855B for Clinics/Group practices and Certain Other Suppliers (PDF, 833 KB)
• CMS-855I for Physicians and Non-Physician Practitioners (PDF, 378 KB)