Telephone & Fax Numbers
Type of Change
Telephone/Fax Numbers at Correspondence Address
CMS 855A Sections Required
Section 1 (A.1,A.2,A.3)
Section 2.C
Section 6 (for authorized representative, if no application is on file.)
Section 15
Type of Change
Telephone/Fax Numbers at Physical Location
CMS 855A Sections Required
Section 1 (A.1,A.2,A.3)
Section 4.A
Section 6 (for authorized representative, if no application is on file.)
Section 15
Special Note - If the practice location and telephone number are changing, the intermediary is permitted by CMS to request an entire CMS 855A application.
Actions Taken by Intermediary
Providers will receive a confirmation letter notifying them that the telephone/fax number has been changed. State agencies will be notified by copy of this letter of the telephone number change.