Provider Enrollment

Providers Enrolled in Medicare in Approved or Opt-Out Status Website

Provider Enrollment Resources

  • PECOS - Click here to enroll, change your Medicare information, and add or delete group members or locations. Then 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, 89 KB) to view your PECOS record using Internet-based PECOS
  • CMS-855 forms access, print, sign and mail to Palmetto GBA:
    Palmetto GBA 
    P.O. Box 100190
    Columbia, SC 29202
  • Dentists to Take Action: CMS-4159-F Medicare Program

Provider Enrollment Tools

Opting Out of Medicare


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Contact Palmetto GBA JM Part B Medicare

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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