Provider Portal

It is important to keep your Medicare Information up to date. You can quickly and easily update this information on the PECOS webpage. Submitting applications via Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Web is the preferred method. It has advantages that include:

View more information about PECOS Web, view the PECOS Web - Enroll and Make Changes Online webpage.

To Change Your Address With Medicare

Hint: If changing from one practice location to another, delete the old location and add the new. An end-date is required to be completed for each location the enrollment is no longer affiliated with.

This video walks you through how to make changes to your PECOS profile - it concentrates on "change of ownership" and not "change of location", but the initial steps are the same: Link to CMS Tutorial

**Instructions on how to fill out your CMS855I Form can be viewed below.

Remember : if you move your office location, you must complete the appropriate CMS-855/CMS-20134 form to update your Medicare address information. The form must bear a handwritten signature of the physician / non-physician practitioner or of the group / organization’s authorized or delegated official.

Stamped signatures are not acceptable.

The most important address is the “special payments” address. This address notifies us where you want all payment information (i.e., checks, notices, etc.) sent. If you do not furnish this address on the CMS-855/CMS-20134 form, it will be returned to you for correction.

We are not permitted to change addresses based on telephone calls, so prompt completion of the CMS-855/CMS-20134 form is imperative to ensure there is no interruption in receiving Medicare checks / notices.

Mail this information to your designated contractor through Medicare (some examples below)

StateUSPSCertified/Courier Mailings
California - Northern
(All Other Counties)		 Noridian JE Part B
Attn: _______ (if applicable)
PO Box 6774
Fargo, ND 58108-6774		 Noridian JE Part B
Attn: _______ (if applicable)
900 42nd St S
PO Box 6774
Fargo, ND 58103-2119
California - Southern
(Counties: Ventura, Los Angeles, Orange, Imperial, San Diego, Santa Barbara and San Luis Obispo)		 Noridian JE Part B
Attn: _______ (if applicable)
PO Box 6775
Fargo, ND 58108-6775		 Noridian JE Part B
Attn: _______ (if applicable)
900 42nd St S
PO Box 6775
Fargo, ND 58103-2119
Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas
 Novitas Solutions
Provider Enrollment Services
P.O. Box 3095
Mechanicsburg, PA 17055-1813
Novitas Solutions
Provider Enrollment Services
P.O. Box 3095
Mechanicsburg, PA 17055-1813
Arizona Noridian JF Part B
Attn: _______ (if applicable)
PO Box 6704
Fargo, ND 58108-6704		 Noridian JF Part B
Attn: _______ (if applicable)
PO Box 6704
Fargo, ND 58108-6704
Washington Noridian JF Part B
Attn: _______ (if applicable)
PO Box 6700
Fargo, ND 58108-6700		 Noridian JF Part B
Attn: _______ (if applicable)
900 42nd St S
PO Box 6700
Fargo, ND 58103-2119

For more information on how to change a practice address, please refer to our Tutorial on How to Change Your Practice Address Location.

Changing a Practice Address on the CMS-855I Form

Step 1

Section 1A - Basic Information: Select “You are reporting a change to your Medicare enrollment information”.

Section 1A Basic Information of the CMS-855I.

Next: Proceed to Section 1B as noted in the far right column.

Step 2

Section 1B – Basic Information : Select “ Address Information ”.

The column titled “Required Sections” lists the sections to complete for the change as 1, 2A, 3, 12, 13 (optional) and 15 and sections 2D, 2E, 4B, 4C and/or 4D as applicable for the address that is being changed.

For this tutorial, we are changing the practice location in section 4B only. If you are changing other addresses on the enrollment application, make sure to complete those sections before submitting the application.

Screenshot of section 1B of CMS-855I.

Next : Find Section 2A.

Step 3

Section 2A – Individual Information: Complete all of the personal information.

Section 2A Personal Information of the CMS-855I.

Next: Find Section 3

Step 4

Section 3 – Final Adverse Legal Actions : Complete the final adverse history.

Section 3 Final Adverse Legal Action of the CMS-855I.

Next : Find Section 4.

Step 5

Section 4B - Practice Location Information : Complete with the new practice address information. Check the change, add, or remove box and provide the date (mm/dd/yyyy) of the practice address change. Complete the practice location name, address line 1, address line 2, city/town, state, zip code +4, telephone number, fax number (if applicable), email address (if applicable), Medicare Identification Number (if issued), primary practice location question, date saw the first Medicare patient at this new location, and practice location type. If any other information about the practice location is changing (i.e. special payment address in Section 4C), complete those sections in addition to Section 4B for the practice location address.

Section 4B Practice location information of the CMS-855I.

Next: Find Section 13.

Step 6

Section 13 – Contact Person : Complete the Contact Person’s information.

This person will be contacted regarding the application, but if a contact person is not listed, the provider will be directly contacted.

Section 13 contact person information of the CMS-855I.

Next : Find Section 15.

Step 7

Section 15 – Certification Statement : Complete this section to certify the submitted information. The signature must be handwritten and dated.

Section 15 Certification statement of the CMS-855I.

Step 8: Mail into the Appropriate Medicare Address

Timeframes for Medicare Changes

Noridian encourages providers/suppliers to make updates online using Internet-Based PECOS Web.

Physicians, non-physicians and organizations (groups) must report the following changes within 30 days of the change taking effect.