Provider 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 https://pecos.cms.hhs.gov. 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
• The CMS file lists Providers eligible to order and refer and those with current enrollment records
• Access instructions (PDF) to view your PECOS record 
• CMS Medicare Provider Enrollment provides enrollment information for all providers
• CMS-855 forms (PDF) 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

• Enrollment Application Tool
• Enrollment Application Status Lookup
• Medicare Revalidation Lookup Tool
• CMS-855O Medicare Enrollment Application Module

Opting Out of Medicare

• Private Contracting