The Revised CMS-855s Enrollment Application

Effective January 7, 2013, DMEPOS suppliers will submit hard copy Medicare enrollment information on the revised CMS-855S application form (1/13). Although the revised application will be available, the existing 855s (7/11) will be accepted during a 120-day grace period. Suppliers are reminded that enrollment information can also be submitted electronically through Internet-based PECOS (Provider Enrollment Chain and Ownership System).

Contact NSC

Email National Supplier Clearinghouse

Contact a specific NSC department

Telephone: 866-238-9652

IVR: 866-238-9652

Address:

National Supplier Clearinghouse

Palmetto GBA, AG-495

P.O. Box 100142

Columbia, SC 29202-3142

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

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Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

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PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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