Provider Enrollment

Provider Enrollment Resources:

  • Enroll, change your Medicare information, and add or delete group members or locations online at https://pecos.cms.hhs.gov. Then electronically sign the application or upload the two-page Certification Statement via PECOS functionality. Contractors can no longer accept mailed paper certification statements. Mail all other supporting paper documentation to Palmetto GBA within seven days of electronic submission.
  • Access the CMS-855A form (PDF, 771 KB). Then print, sign and mail it to Palmetto GBA.
  • Access the status of your CMS-855 application
  • CMS file: providers eligible to order/refer and with current enrollment records
  • Enrollment Application Status Lookup
  • Medicare Revalidation Lookup Tool
  • Palmetto GBA address for mailing enrollment forms:

    Palmetto GBA
    Part A Provider Enrollment (AG-331)
    2300 Springdale Drive, BLDG One
    Camden, SC 29020 

Please Select a Topic:

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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