Changes to Provider Enrollment Information: Questions and Answers
1) What is the procedure for changing my enrollment information?
Changes to information on Medicare enrollment records must be reported within 30 or 90 days after the effective date of the change, depending on the type of provider involved and the type of change being reported. Please refer to "Reporting Changes of Information" http://www.wpsmedicare.com/part_b/business/add_chng_report.shtml to determine the required timeframes for reporting specific changes of information.
Changes must be reported on the appropriate 2008 enrollment form. Note that these forms require that the NPI be reported. Copies of appropriate documents needed to support the requested change must be included with the enrollment form.
An NPI is not required for changes of information reporting a voluntary termination or the death of a provider, if the provider has not previously obtained an NPI.
An individual or entity reporting a change of information may be required to submit a complete CMS 855I or CMS 855B to update their Medicare enrollment information. If the required CMS 855I or CMS 855B is not submitted within 60 days of the request, the change of information will not be processed, and the provider's Medicare enrollment will be subject to revalidation requirements per 42 CFR § 424.515.
Note: If an enrolled entity obtains a new employer identification number, it is not considered a "change of information" for Medicare enrollment purposes. Rather, it is considered a new entity, and a new enrollment form must be completed in its entirety.
You may also report most types of changes or enroll via the Internet-based Provider Enrollment Chain and Ownership System (PECOS). To apply via the Internet-based PECOS, go to: http://www.cms.hhs.gov/MedicareProviderSupEnroll/ 
Please contact our Provider Enrollment Department to verify that you are completing the correct forms for your situation.
2) I originally enrolled with a temporary license and am now ready to submit my permanent license. How do I report this to WPS?
Submit your permanent license information on the CMS 855I application form as a change of information, including a new signature and date in Section 15. Include your NPI on the form and enclose a copy of your permanent license.
Page Last Updated: Thursday, 18-Mar-2010 05:56:20 CDT
