Provider Enrollment

Published 03/09/2022

If you are a provider interested in serving Medicare patients, CMS requires you to be enrolled with Medicare. The links below will provide you with the tools and information needed to quickly and efficiently complete your Medicare enrollment.

Provider Enrollment Resources

  • Enroll, change your Medicare information, and add or delete group members or locations using the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) at 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.
  • Provider Enrollment Revalidation
  • CMS file: providers eligible to order/refer and with current enrollment records
  • Access instructions (PDF) to view your PECOS record using Internet-based PECOS
  • CMS Medicare Provider Enrollment: enrollment information for all providers
  • CMS-855 forms access, print, sign and mail to Palmetto GBA:

Palmetto GBA 
Mail Code: AG-310
P.O. Box 100306
Columbia, SC 29202-3306

Provider Enrollment Tools

Opting Out of Medicare

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