Fields with a red asterisk ( * ) are required.
Error - Invalid NPI
Error - You must acknowledge receipt.
Note: You are required to report this initial data requirement and in the Medicare GADCS during your organization’s data reporting period.
Is your organization still in operation?
If your organization is still in operation, do you provide ground ambulance services?
Please provide the name, title, and email address for the person you want CMS to keep updated regarding this requirement.
Please ensure your contacts are the individuals that are associated with submitting and certifying the data.
Error - Email Address is a required field.
Error - Email Addresses do not match.
Error - Title is a required field.
Error - Street address is required.
Error - City, State and Zip are required.
If you would like to specify a second contact please provide the name, title, email address, phone number, and mailing address for that person.
Please ensure your contacts are the individuals that are associated with submitting and certifying the data.
Error - Email Address is a required field.
Error - Email Addresses do not match.
Error - Title is a required field.
Error - Street address is required.
Error - City, State and Zip are required.
Please provide the name, title, and email address for the person you want CMS to keep updated regarding this requirement.
Please ensure your contacts are the individuals that are associated with submitting and certifying the data.
Error - Email Address is a required field.
Error - Email Addresses do not match.
Error - Title is a required field.
Error - Street address is required.
Error - City, State and Zip are required.
Error Message Text.
v2023-06-17-4