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Medicare Fee-for-Service Provider Enrollment Contact List Medicare operations are managed by independent contractors known as fee-for-service contractors. The Medicare fee-for-service contractor serving your State or jurisdiction will answer your enrollment questions and process your enrollment application. A carrier processes enrollment applications submitted by physicians, non-physician practitioners, and the following organizations: Ambulance Service Supplier Independent Diagnostic Testing Facility Slide Preparation Facility Ambulatory Surgical Center Mammography Center Voluntary Health/Charitable Agency Clinics & Group Practices Portable X-ray Supplier Independent Clinical Laboratory Radiation Therapy Center Note: If your supplier type is not shown above, contact a the designated carrier before you submit an enrollment application. A fiscal intermediary processes enrollment applications submitted by the following health care organizations: Community Mental Health Center Home Health Agency Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services Comprehensive Outpatient Rehab Facility Hospice Religious Non-Medical Health Care Institution Critical Access Hospital Hospital Skilled Nursing Facility End-Stage Renal Disease Facility Indian Health Services Facility Histocompatibility Laboratory Organ Procurement Organization Note: If your provider or supplier type is not shown above, contact a the designated fiscal intermediary before you submit an enrollment application. The National Supplier Clearinghouse processes enrollment applications submitted by Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. State Medicare Fee-for-Service Contractor Medicare Contractor Name Telephone Number Mailing Address Web Site Address Alabama Carrier Cahaba GBA 866-539-5598 Provider Enrollment, P.O. Box 830170, Birmingham, AL 35202 http://www.cahabagba.com Fiscal Intermediary Cahaba GBA 866-539-5598 Provider Audit and Reimbursement, P.O. Box 361930, Birmingham, AL 35236-1930 http://www.cahabagba.com Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/ Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/ Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc Alaska Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6703, Fargo, ND 58108-6703 http://www.noridianmedicare.com/ Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6720 Fargo, ND 58108-6720 http://www.noridianmedicare.com/ Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/ Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/ Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com/home/home.do National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc American Samoa Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/ Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/ Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/ Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/ Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 ATTN: Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

PECOS MAC List

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Page 1: PECOS MAC List

Medicare Fee-for-Service Provider Enrollment Contact List

Medicare operations are managed by independent contractors known as fee-for-service contractors.

The Medicare fee-for-service contractor serving your State or jurisdiction will answer your enrollment questions and process your enrollment application.

A carrier processes enrollment applications submitted by physicians, non-physician practitioners, and the following organizations:

Ambulance Service Supplier Independent Diagnostic Testing Facility Slide Preparation Facility

Ambulatory Surgical Center Mammography Center Voluntary Health/Charitable Agency

Clinics & Group Practices Portable X-ray Supplier

Independent Clinical Laboratory Radiation Therapy Center

Note: If your supplier type is not shown above, contact a the designated carrier before you submit an enrollment application.

A fiscal intermediary processes enrollment applications submitted by the following health care organizations:

Community Mental Health Center Home Health Agency Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services

Comprehensive Outpatient Rehab Facility Hospice Religious Non-Medical Health Care Institution

Critical Access Hospital Hospital Skilled Nursing Facility

End-Stage Renal Disease Facility Indian Health Services Facility

Histocompatibility Laboratory Organ Procurement Organization

Note: If your provider or supplier type is not shown above, contact a the designated fiscal intermediary before you submit an enrollment application.

The National Supplier Clearinghouseprocesses enrollment applications submitted by Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers.

State Medicare Fee-for-Service Contractor Medicare Contractor Name Telephone Number Mailing Address Web Site Address

Alabama Carrier Cahaba GBA 866-539-5598 Provider Enrollment, P.O. Box 830170, Birmingham, AL 35202 http://www.cahabagba.com

Fiscal Intermediary Cahaba GBA 866-539-5598 Provider Audit and Reimbursement, P.O. Box 361930, Birmingham, AL 35236-1930 http://www.cahabagba.com

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Alaska Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6703, Fargo, ND 58108-6703 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6720 Fargo, ND 58108-6720 http://www.noridianmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com/home/home.do

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

American Samoa Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/

Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 ATTN: Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

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National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Arizona Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6704, Fargo, ND 58108-6704 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6730, Fargo, ND 58108-6730 http://www.noridianmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center Noridian Administrative Services 888-608-8816 P.O. Box 6730, Fargo, ND 58108-6730 http://www.noridianmedicare.com/

Rural Health Clinic Noridian Administrative Services 888-608-8816 P.O. Box 6730, Fargo, ND 58108-6730 http://www.noridianmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Arkansas Carrier Pinnacle Business Solutions 866-582-3251 Provider Enrollment, P.O. Box 34260, Little Rock, Arkansas 72203 http://www.pinnaclebsi.com/

Fiscal Intermediary Pinnacle Business Solutions 888-733-6820 Provider Enrollment,Provider Audit & Reimbursement, P.O. Box 1418, Little Rock, AR 72203 http://www.pinnaclebsi.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic TrailBlazer Heath Enterprises, LLC 866-528-1603 P.O. Box 650458 Dallas, Texas 75265-0458 http://www.trailblazerhealth.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

California Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/

Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 Provider Enrollment, P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com/home/home.do

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Colorado Carrier TrailBlazer Health Enterprises, LLC 866-539-5596 Provider Enrollment, P.O. Box 650710, Dallas, TX 75265-0710 http://www.trailblazerhealth.com/

Fiscal Intermediary TrailBlazer Health Enterprises, LLC 866-528-1603 P.O. Box 650458 Dallas, Texas 75265-0458 http://www.trailblazerhealth.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic TrailBlazer Health Enterprises, LLC 866-528-1603 P.O. Box 650458, Dallas, Texas 75265-0458 http://www.trailblazerhealth.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Connecticut Carrier National Government Services, Inc. 888-855-4356 P.O. Box 4887, Syracuse, New York 13221-4887 http://www.ngsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 888-855-4356 P.O. Box 4846, Syracuse, New York 13221-4846 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

District of Columbia Carrier Highmark Medicare Services 866-488-0549, option 1 Provider Enrollment Services, PO Box 890408, Camp Hill, PA 17089-0408 http://www.highmarkmedicareservices.com/

Fiscal Intermediary Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890386 Camp Hill, Pennsylvania 17089-0386 http://www.highmarkmedicareservices.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 3: PECOS MAC List

Delaware Carrier Highmark Medicare Services 866-488-0549, option 1 Provider Enrollment Services, PO Box 890408, Camp Hill, PA 17089-0408 http://www.highmarkmedicareservices.com/

Fiscal Intermediary National Government Services, Inc. 888-855-4356 P.O. Box 4846, Syracuse, NY 13221-4846 http://www.ngsmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Florida Carrier First Coast Service Options 866-454-9007 Medicare Provider Enrollment (Florida Part B), P.O. Box 44021, Jacksonville, FL 32231-4021 http://www.fcso.com/

Fiscal Intermediary First Coast Service Options 877-602-8816 Medicare Provider Enrollment (Florida Part A), P.O. Box 45169, Jacksonville, FL 32232-5169 http://www.fcso.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Georgia Carrier Cahaba GBA 877-567-7271 Provider Enrollment, P.O. Box 12967, Birmingham, AL 35202 http://www.cahabagba.com/

Fiscal Intermediary Blue Cross Blue Shield of Georgia 877-567-3095Provider Enrollment (PA&R Dept), 2357 Warm Springs Road, Columbus, Georgia 31904 or P.O. Box9048, Columbus, GA 31908-9048 http://www.georgiamedicare.com/enrollment.cfm

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Guam Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/

Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 ATTN: Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Hawaii Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/

Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 Provider Enrollment, P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Idaho Carrier CIGNA Government Services 866-520-4007 P.O. Box 25226, Nashville, TN 37202 http://www.cignagovernmentservices.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6726, Fargo, ND 58108-6726 http://www.noridianmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 4: PECOS MAC List

Illinois Carrier Wisconsin Physicians Service 877-908-8476 Medicare Part B Provider Enrollment, P.O. Box 8248, Madison, Wisconsin 53708-8248 http://www.wpsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 317-841-4540 Part A Provider Enrollment, P.O. Box 7078, Indianapolis, IN 46207-7078 http://www.ngsmedicare.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 423-535-5124 Provider Enrollment-3C, 730 Chestnut St., Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Indiana Carrier National Government Services, Inc. 866-250-5665 Medicare Part B Provider Enrollment, P.O. Box 7078, Indianapolis, IN 46207-7078 http://www.ngsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 317-841-4540 Part A Provider Enrollment, P.O. Box 7078, Indianapolis, IN 46207-7078 http://www.ngsmedicare.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 423-535-5124 Provider Enrollment-3C, 730 Chestnut St., Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Iowa Carrier Wisconsin Physicians Service 866-503-7664 Provider Enrollment, P.O.Box 8248, Madison, WI 53708 www.wpsmedicare.com

Fiscal Intermediary Wisconsin Physicians Service 866-503-7664 WPS Provider Enrollment, 3333 Farnam St. Suite 700 Omaha, Nebraska 68101 www.wpsmedicare.com

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Kansas Carrier Wisconsin Physicians Service 866-503-7664 Provider Enrollment, P.O.Box 8248, Madison, WI 53708 www.wpsmedicare.com

Fiscal Intermediary Wisconsin Physicians Service 866-734-9444 Provider Enrollment, P.O.Box 8310, Omaha, NE 68108-0310 www.wpsmedicare.com

Regional Home Health Intermediary Cahaba GBA, LLC 877-299-4500 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Kentucky Carrier National Government Services, Inc. 866-250-5665 Medicare Part B Provider Enrollment, P.O. Box 7158, Indianapolis, IN 46207-7158 http://www.ngsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 513-419-4232 Part A Provider Enrollment, P.O. Box 7141, Indianapolis, IN 46207-7141 http://www.ngsmedicare.com/

Regional Home Health Intermediary Palmetto GBA 877-272-5786 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com/home/home.do

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Louisiana Carrier Pinnacle Business Solutions 886-794-0466 P.O. Box 83860, Baton Rouge, LA 70884-3860 http://www.pinnaclebsi.com/

Fiscal Intermediary TriSpan Health Services 877-635-7596 P.O. Box 23046 Jackson, MS 39225-3046 http://www.trispan.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic TrailBlazer Health Enterprises, LLC 866-528-1603 P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 5: PECOS MAC List

Maine Carrier NHIC, Corp. 877-258-4442 Provider Enrollment, P.O. Box 3434, Hingham, MA 02044 http://www.medicarenhic.com/

Fiscal Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Maryland Carrier Highmark Medicare Services 866-488-0549, option 1 Provider Enrollment Services, PO Box 890407, Camp Hill, PA 17089-0407 http://www.highmarkmedicareservices.com/

Fiscal Intermediary Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, PO Box 890386, Camp Hill, PA 17089-0386 http://www.highmarkmedicareservices.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Massachusetts Carrier NHIC, Corp. 877-527-6594 Provider Enrollment, P.O. Box 3434, Hingham, MA 02044 http://www.medicarenhic.com/

Fiscal Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Michigan Carrier Wisconsin Physicians Service 877-908-8476 Medicare Part B Provider Enrollment, P.O. Box 8248, Madison, Wisconsin 53708-8248 http://www.wpsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 423-535-5124 Provider Enrollment-3C, 730 Chestnut St., Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Minnesota Carrier Wisconsin Physicians Service 866-564-0315 8120 Penn Avenue South, Suite 200, Bloomington, MN 55431-1394 http://www.wpsmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6714 Fargo, ND 58108-6714 http://www.noridianmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 423-535-5124 Provider Enrollment-3C, 730 Chestnut St., Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Mississippi Carrier Cahaba GBA 866-419-9454 Provider Enrollment, P.O. Box 548, Birmingham, AL 35202 http://www.cahabagba.com/

Fiscal Intermediary TriSpan Health Services 877-635-7596 P.O. Box 23046, Jackson, MS 39225-3046 http://www.trispan.com/

Regional Home Health Intermediary Palmetto GBA 877-272-5786 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Freestanding Federally Qualified Health Centers National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinics Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 6: PECOS MAC List

Missouri Carrier Wisconsin Physicians Service 866-503-7664 Provider Enrollment, P.O.Box 8248, Madison, WI 53708 www.wpsmedicare.com

Fiscal Intermediary TriSpan Health Services 877-635-7596 P.O. Box 23046, Jackson, MS 39225-3046 http://www.trispan.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Montana Carrier Noridian Administrative Services 888-608-8816 Medicare Part B, P.O. Box 6735, Fargo, ND 58108-6735 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6732, Fargo, ND 58108-6732 http://www.noridianmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6732, Fargo, ND 58108-6732 http://www.noridianmedicare.com/

Rural Health Clinic Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6732, Fargo, ND 58108-6732 http://www.noridianmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Nebraska Carrier Wisconsin Physicians Service 866-503-7664 Provider Enrollment, P.O.Box 8248, Madison, WI 53708 www.wpsmedicare.com

Fiscal Intermediary Wisconsin Physicians Service 866-734-9444 Provider Enrollment, P.O.Box 8310, Omaha, NE 68108-0310 www.wpsmedicare.com

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Nevada Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/

Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 Provider Enrollment, P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

New Hampshire Carrier NHIC, Corp. 877-258-4442 Provider Enrollment, P.O. Box 3434, Hingham, MA 02044 http://www.medicarenhic.com/

Fiscal Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

New Jersey Carrier National Government Services, Inc. 888-855-4346 P.O. Box 69218, Harrisburg , PA 17106-9218 http://www.ngsmedicare.com/

Fiscal Intermediary Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 7: PECOS MAC List

New Mexico Carrier TrailBlazer Health Enterprises, LLC 866-539-5596 Provider Enrollment, P.O. Box 650709, Dallas, TX 75265-0709 http://www.trailblazerhealth.com/

Fiscal Intermediary TrailBlazer Health Enterprises, LLC 866-528-1603 Provider Enrollment, P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic TrailBlazer Health Enterprises, LLC 866-528-1603 Provider Enrollment, P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

New York (Upstate) Carrier National Government Services, Inc. 877-567-7173 P.O. Box 4893, Syracuse, NY 13221-4893 http://www.ngsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 888-855-4356 P.O. Box 4846, Syracuse , NY 13221-4846 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

New York (NYC Metroarea, except Queens) Carrier National Government Services, Inc. 866-837-0241 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/Counties: Bronx, Columbia,Delaware, Dutchess, Greene, Fiscal Intermediary National Government Services, Inc. 888-855-4356 P.O. Box 4846, Syracuse, NY 13221-4846 http://www.ngsmedicare.com/Kings (Brooklyn), Nassau, NewYork (Manhattan), Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/Orange, Putnam, Richmond (StatenIsland), Rockland, Freestanding Federally Qualified Health Centers National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/Suffolk, Sullivan, Ulster,Westchester Rural Health Clinics Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

New York (Queens) Carrier National Government Services, Inc. 866-837-0241 P.O. Box 4885, Syracuse, NY 13221-4885 http://www.ngsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 888-855-4356 P.O. Box 4846, Syracuse, NY 13221-4846 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

North Carolina Carrier CIGNA Government Services 866-520-4007 Provider Enrollment, P.O. Box 25226, Nashville, TN 37202 http://www.cignagovernmentservices.com/

Fiscal Intermediary Palmetto GBA 877-567-9249 Part A Provider Enrollment, 2300 Springdale Drive, Building One Camden, SC 29020 http://www.palmettogba.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

North Dakota Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6706, Fargo, ND 58108-6706 https://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6709, Fargo, ND 58108-6709 https://www.noridianmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center Noridian Administrative Services 888-608-8816 P.O. Box 6709, Fargo, ND 58108-6709 https://www.noridianmedicare.com/

Rural Health Clinic Noridian Administrative Services 888-608-8816 P.O. Box 6709, Fargo, ND 58108-6709 https://www.noridianmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 8: PECOS MAC List

Northern Carrier Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1667, Augusta, GA 30903-1667 http://www.palmettogba.com/

Mariana Fiscal Intermediary Palmetto GBA 866-931-3901 Provider Enrollment, P.O. Box 1508, Augusta, GA 30903-1508 http://www.palmettogba.com/

Islands Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Ohio Carrier Palmetto GBA 866-308-5439 Part B Provider Enrollment, P.O. Box 182933, Columbus, OH 43218-2933 http://www.palmettogba.com/

Fiscal Intermediary National Government Services, Inc. 513-852-4232 Part A Provider Enrollment, P.O. Box 7141, Indianapolis, IN 46207-7141 http://www.ngsmedicare.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Oklahoma Carrier TrailBlazer Health Enterprises, LLC 866-539-5596 Provider Enrollment, P.O. Box 650711, Dallas, TX 75265-0711 http://www.trailblazerhealth.com/

Fiscal Intermediary TrailBlazer Health Enterprises, LLC 866-528-1603 Provider Enrollment, P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic TrailBlazer Health Enterprises, LLC 866-528-1603 Provider Enrollment, P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Oregon Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6702, Fargo, ND 58108-6702 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6726, Fargo, ND 58108-6726 http://www.noridianmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Pennsylvania Carrier Highmark Medicare Services 866-488-0549, option 1 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

Fiscal Intermediary Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Puerto Rico Carrier Triple-S, Inc./Medicare 888-889-0325 P.O. Box 71391, San Juan, PR 00936 http://www.triples-med.org

Fiscal Intermediary COSVI 787-758-9733 P.O. Box 45169, Jacksonville, FL 32232-5169 http://www.cosvimedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-226-6972 / 6997 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 9: PECOS MAC List

Rhode Island Carrier Pinnacle Business Solutions 866-582-3251 Provider Enrollment, Post Office Box 34260, Little Rock, Arkansas 72203 http://www.pinnaclebsi.com/

Fiscal Intermediary Pinnacle Business Solutions 888-733-6820 Part A Provider Enrollment, P.O. Box 1418, Little Rock, AR 72203 http://www.pinnaclebsi.com/

Regional Home Health Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

South Carolina Carrier Palmetto GBA 866-238-9654 Part B Provider Enrollment (AG-310), P.O. Box 100190, Columbia, SC 29202-3190 http://www.palmettogba.com/

Fiscal Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

South Dakota Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6707, Fargo, ND 58108-6707 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6733, Fargo, ND 58108-6733 http://www.noridianmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center Noridian Administrative Services 888-608-8816 P.O. Box 6733, Fargo, ND 58108-6733 http://www.noridianmedicare.com/

Rural Health Clinic Noridian Administrative Services 888-608-8816 P.O. Box 6733, Fargo, ND 58108-6733 http://www.noridianmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Tennessee Carrier CIGNA Government Services 866-520-4007 Provider Enrollment, P.O. Box 25226, Nashville, TN 37202 http://www.cignamedicare.com/

Fiscal Intermediary Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment - 3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Texas Carrier TrailBlazer Health Enterprises, LLC 866-528-1602 Provider Enrollment, P.O. Box 650544, Dallas, TX 75265-0544 http://www.trailblazerhealth.com/

Fiscal Intermediary TrailBlazer Health Enterprises, LLC 866-528-1603 Provider Enrollment, P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

Regional Home Health Intermediary Palmetto GBA 803-382-6167 Part A Provider Enrollment (AG-331), P.O. Box 100144, Columbia, SC 29202-3144 http://www.palmettogba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic TrailBlazer Health Enterprises, LLC 866-528-1603 Provider Enrollment, P.O. Box 650458, Dallas, TX 75265-0458 http://www.trailblazerhealth.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Utah Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6725, Fargo, ND 58108-6725 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6724, Fargo, ND 58108-6724 http://www.noridianmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6724, Fargo, ND 58108-6724 http://www.noridianmedicare.com/

Rural Health Clinic Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6724, Fargo, ND 58108-6724 http://www.noridianmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 10: PECOS MAC List

Vermont Carrier NHIC, Corp. 877-258-4442 Provider Enrollment, P.O. Box 3434, Hingham, MA 02044 http://www.medicarenhic.com/

Fiscal Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic National Government Services, Inc. 866-539-5593 P.O. Box 4792, Syracuse, NY 13221-4792 http://www.ngsmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Virginia Carrier TrailBlazer Health Enterprises 866-697-9670 Provider Enrollment VA, P.O. Box 650707, Dallas, TX 75265-0707 http://www.trailblazerhealth.com/

Fiscal Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Virgin Island Carrier Triple-S, Inc./Medicare 888-889-0325 P.O. Box 71391, San Juan, PR 00936 http://www.triples-med.org

Fiscal Intermediary COSVI 787-758-9733 P.O.Box 45169, Jacksonville, FL 22232-5169 http://www.cosvimedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Washington Carrier Noridian Administrative Services 888-608-8816 P.O. Box 6700, Fargo, ND 58108-6700 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 P.O. Box 6720, Fargo, ND 58108-6720 http://www.noridianmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 513-852-4275 Provider Enrollment, P.O. Box 7143, Indianapolis, IN 46207-7143 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

West Virginia Carrier Palmetto GBA 866-308-5439 Palmetto GBA, Part B Provider Enrollment, P.O. Box 182933, Columbus, OH 43218-2933 http://www.palmettogba.com/

Fiscal Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Highmark Medicare Services 866-488-0549, option 2 Provider Enrollment Services, P.O. Box 890157, Camp Hill, PA 17089-0157 http://www.highmarkmedicareservices.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Wisconsin Carrier Wisconsin Physicians Service 877-908-8476 WPS-Medicare Provider Enrollment, P.O. Box 8248, Madison, Wisconsin 53708-8248 http://www.wpsmedicare.com/

Fiscal Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Regional Home Health Intermediary National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Federally Qualified Health Center National Government Services, Inc. 414-459-6972 P.O. Box 7149, Indianapolis, IN 46207-7149 http://www.ngsmedicare.com/

Rural Health Clinic Riverbend Government Benefits Administrator, Inc. 877-296-6189 Provider Enrollment-3C, 730 Chestnut Street, Chattanooga, TN 37402 http://www.rgbagov.com

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc

Page 11: PECOS MAC List

Wyoming Carrier Noridian Administrative Services 888-608-8816 Medicare Part B, P.O. Box 6708, Fargo, ND 58108-6708 http://www.noridianmedicare.com/

Fiscal Intermediary Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6734, Fargo, ND 58108-6734 http://www.noridianmedicare.com/

Regional Home Health Intermediary Cahaba GBA, LLC877-299-4500 (HHA)866-539-5592 (Hospice) 400 E. Court, Station 27, P.O. Box 14537, Des Moines, IA 50306-3537 http://www.cahabagba.com/

Federally Qualified Health Center Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6734, Fargo, ND 58108-6734 http://www.noridianmedicare.com/

Rural Health Clinic Noridian Administrative Services 888-608-8816 Medicare Part A, P.O. Box 6734, Fargo, ND 58108-6734 http://www.noridianmedicare.com/

National Supplier Clearinghouse Palmetto GBA 866-238-9652 P.O. Box 100142, Columbia, South Carolina 29202-3142 http://www.palmettogba.com/nsc