Provider Address Changes: Important Reminder

If you are credentialed with Palmetto GBA as a Medicare provider, you must notify Palmetto GBA within 30 days of any changes that occur within your practice location(s). These changes include but are not limited to:

  • Any address change
    • 'Pay to' address
    • Email address
    • Practice location
    • Billing agency address
    • Mailing address ('correspondence address')
  • Medical specialty
  • Name
  • Telephone number
  • Potential change/termination of current ownership
  • Authorized/delegated officials
  • Fax number
  • Deactivation of Medicare billing numbers (such as a provider that has retired or left a group)
  • Contact person
  • Billing agency
All changes must be submitted on the CMS-855B or CMS 855-I application.

Please Note: Failure to notify our office of these important changes may delay the reimbursement and issuance of checks and Remittance Advice statements (both electronic and paper).
 
Options for submitting changes:
  • Complete an online application
    • Update or enroll using Internet-based PECOS as an alternative to submitting paper applications. Refer to the CMS website for more details and to access the online system.

      The two-page Certification Statement must be mailed to Palmetto GBA within seven days of your electronic submission.

  • Download and submit on paper
    • CMS 855B (PDF, 661 KB): Application for Health Care Suppliers that will Bill Medicare Carriers (including group practices)
    • CMS 855I (PDF, 523 KB): Application for Individual Health Care Practitioners. 
  • Mail completed applications to:

 JJ Part B JM Part B

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

Palmetto GBA
Mail Code: AG-310
P.O. Box 100190
Columbia, SC 29202-3190 

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B 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

Anonymous

 


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