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Ohio Part B Carrier
Provider Enrollment
Provider Enrollment Resources:
Enroll, change your Medicare information, and add or delete group members or locations online:
https://pecos.cms.hhs.gov
(print, sign and date the two-page Certification Statement and mail the Certification Statement and all supporting paper documentation to Palmetto GBA within seven days of electronic submission)
Access
CMS-855 forms
(then print, sign and mail to Palmetto GBA)
Palmetto GBA mailing addresses
Access the status of your CMS-855 application
Guidance on which form to complete
Contact the Provider Enrollment Support Line at (866) 308-5439 for additional assistance
Provider Enrollment
855 Application
General
IDTF
Opt Out
last updated on 11/20/2009