Obtaining a CMS 855A

Hardcopy Package - Contact Palmetto GBA

Home Health and Hospice Providers - 866-801-5301
Part A Providers - 877-567-9249

Electronic Version - CMS 855A Provider/Supplier Enrollment Application

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Change of Information

....Adding/Deleting an Additional Location

....Change of Management Company

....Obtaining a CMS 855A

....Address Changes

....Where to Send Changes of Information

....Change of Name

....Other Helpful Hints/Reminders

....Contacting Palmetto GBA about Changes of Information

....Delegated Official

....Authorized Representative

....Changes that do NOT require an 855A

....Voluntary Termination

....Telephone & Fax Numbers

....Change in Management Personnel & Board Members Section 6

....Stock Transfers

....Home Office

....Billing Agent