Comprehensive Outpatient Rehab Facility Home Health Agency (HHA) Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services

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1 Medicare operations are managed by independent contractors known as fee-for-service contractors. An A/B MAC or carrier processes enrollment applications submitted by physicians, non-physician practitioners, and the following organizations: Medicare Fee-for-Service Provider Enrollment Contact List The Medicare fee-for-service contractor serving your State or jurisdiction will answer your enrollment questions and process your enrollment application. Ambulance Service Supplier Ambulatory Surgical Center Clinics & Group Practices Independent Clinical Laboratory Independent Diagnostic Testing Facility Mammography Center Portable X-ray Supplier Radiation Therapy Center Note: If your supplier type is not shown above, contact a the designated carrier before you submit an enrollment application. An A/B MAC or fiscal intermediary processes enrollment applications submitted by the following health care organizations: Community Mental Health Center Histocompatibility Laboratory Organ Procurement Organization Comprehensive Outpatient Rehab Facility Home Health Agency (HHA) Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services Critical Access Hospital Hospice Religious Non-Medical Health Care Institution End-Stage Renal Disease Facility Hospital Rural Health Center Federally Qualified Health Center Indian Health Services Facility Skilled Nursing Facility 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. Alabama Carrier Cahaba GBA Provider Enrollment, P.O. Box , Birmingham, AL Fiscal Intermediary Cahaba GBA Provider Enrollment - Part A, P.O. Box 1537, Birmingham, AL Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC

2 Alaska Carrier Noridian Administrative Services P.O. Box 6703, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6720 Fargo, ND Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN American Samoa Carrier Palmetto GBA Provider Enrollment, P.O. Box 1667, Augusta, GA Fiscal Intermediary Palmetto GBA Provider Enrollment, P.O. Box 1508, Augusta, GA Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Arizona Carrier Noridian Administrative Services P.O. Box 6704, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6730, Fargo, ND Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Arkansas Carrier Pinnacle Business Solutions Provider Enrollment, P.O. Box 34260, Little Rock, Arkansas Fiscal Intermediary Pinnacle Business Solutions Provider Enrollment, P.O. Box 1418, Little Rock, AR Regional Home Health Intermediary Palmetto GBA Provider Enrollment (AG-331), P.O. Box , Columbia, SC California Carrier Palmetto GBA Provider Enrollment, P.O. Box 1667, Augusta, GA Fiscal Intermediary Palmetto GBA Provider Enrollment, P.O. Box 1508, Augusta, GA Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN

3 Colorado Carrier TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX Fiscal Intermediary TrailBlazer Health Enterprises, LLC P.O. Box Dallas, Texas (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Connecticut Carrier National Government Services, Inc P.O. Box 4887, Syracuse, New York Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY District of Columbia Carrier Fiscal Intermediary Regional Home Health Intermediary Highmark Medicare Services Highmark Medicare Services Cahaba GBA, LLC , option 1 Provider Enrollment Services, PO Box , Camp Hill, PA , option 2 Provider Enrollment Services, P.O. Box Camp Hill, Pennsylvania (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA Delaware Carrier Highmark Medicare Services , option 1 Provider Enrollment Services, P.O. Box , Camp Hill, PA Fiscal Intermediary Regional Home Health Intermediary Highmark Medicare Services Cahaba GBA, LLC , option 2 Provider Enrollment Services, P.O. Box , Camp Hill, PA (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA Florida Carrier First Coast Service Options Provider Enrollment, P.O. Box 44021, Jacksonville, FL Fiscal Intermediary First Coast Service Options Provider Enrollment, P.O. Box 44021, Jacksonville, FL

4 Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC

5 Georgia Carrier Cahaba GBA Provider Enrollment, P.O. Box 12967, Birmingham, AL Fiscal Intermediary Cahaba GBA Provider Enrollment - Part A, P.O. Box 1537, Birmingham, AL Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Guam Carrier Palmetto GBA Provider Enrollment, P.O. Box 1667, Augusta, GA Fiscal Intermediary Palmetto GBA Provider Enrollment, P.O. Box 1508, Augusta, GA Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Hawaii Carrier Palmetto GBA Provider Enrollment, P.O. Box 1667, Augusta, GA Fiscal Intermediary Palmetto GBA Provider Enrollment, P.O. Box 1508, Augusta, GA Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Idaho Carrier CIGNA Government Services P.O. Box 25226, Nashville, TN Fiscal Intermediary Noridian Administrative Services P.O. Box 6726, Fargo, ND Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Illinois Carrier Wisconsin Physicians Service Medicare Part B Provider Enrollment, P.O. Box 8248, Madison, Wisconsin Fiscal Intermediary National Government Services, Inc Part A Provider Enrollment, P.O. Box 7078, Indianapolis, IN Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC

6 Indiana Carrier National Government Services, Inc Medicare Part B Provider Enrollment, P.O. Box 7078, Indianapolis, IN Fiscal Intermediary National Government Services, Inc Part A Provider Enrollment, P.O. Box 7078, Indianapolis, IN Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Iowa Carrier Wisconsin Physicians Service Provider Enrollment, P.O.Box 8248, Madison, WI Fiscal Intermediary Wisconsin Physicians Service WPS Provider Enrollment, 3333 Farnam St. Suite 700 Omaha, Nebraska (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Kansas Carrier Wisconsin Physicians Service Provider Enrollment, P.O.Box 8248, Madison, WI Fiscal Intermediary Wisconsin Physicians Service Provider Enrollment, P.O.Box 8310, Omaha, NE Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Kentucky Carrier National Government Services, Inc Medicare Part B Provider Enrollment, P.O. Box 7158, Indianapolis, IN Fiscal Intermediary National Government Services, Inc Part A Provider Enrollment, P.O. Box 7141, Indianapolis, IN Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Louisiana Carrier Pinnacle Business Solutions P.O. Box 34260, Little Rock, AR Fiscal Intermediary TriSpan Health Services P.O. Box Jackson, MS Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC

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8 Maine Carrier NHIC, Corp Provider Enrollment, P.O. Box 3434, Hingham, MA Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Maryland Carrier Highmark Medicare Services , option 1 Provider Enrollment Services, PO Box , Camp Hill, PA Fiscal Intermediary Regional Home Health Intermediary Highmark Medicare Services Cahaba GBA, LLC , option 2 Provider Enrollment Services, PO Box , Camp Hill, PA (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA Massachusetts Carrier NHIC, Corp Provider Enrollment, P.O. Box 3434, Hingham, MA Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Michigan Carrier Wisconsin Physicians Service Medicare Part B Provider Enrollment, P.O. Box 8248, Madison, Wisconsin Fiscal Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN Minnesota Carrier Wisconsin Physicians Service Penn Avenue South, Suite 200, Bloomington, MN Fiscal Intermediary Noridian Administrative Services P.O. Box 6714 Fargo, ND Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN

9 Mississippi Carrier Cahaba GBA Provider Enrollment, P.O. Box 548, Birmingham, AL Fiscal Intermediary TriSpan Health Services P.O. Box 23046, Jackson, MS Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Missouri Carrier Wisconsin Physicians Service Provider Enrollment, P.O.Box 8248, Madison, WI Fiscal Intermediary Wisconsin Physicians Service Provider Enrollment, P.O.Box 8310, Omaha, NE (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Montana Carrier Noridian Administrative Services Medicare Part B, P.O. Box 6735, Fargo, ND Fiscal Intermediary Noridian Administrative Services Medicare Part A, P.O. Box 6732, Fargo, ND (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Nebraska Carrier Wisconsin Physicians Service Provider Enrollment, P.O.Box 8248, Madison, WI Fiscal Intermediary Wisconsin Physicians Service Provider Enrollment, P.O.Box 8310, Omaha, NE (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Nevada Carrier Palmetto GBA Provider Enrollment, P.O. Box 1667, Augusta, GA Fiscal Intermediary Palmetto GBA Provider Enrollment, P.O. Box 1508, Augusta, GA Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN

10 New Hampshire Carrier NHIC, Corp Provider Enrollment, P.O. Box 3434, Hingham, MA Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY New Jersey Carrier Highmark Medicare Services , option 1 Provider Enrollment Services, P.O. Box , Camp Hill, PA Fiscal Intermediary Highmark Medicare Services , option 2 Provider Enrollment Services, P.O. Box , Camp Hill, PA Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN New Mexico Carrier TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX Fiscal Intermediary TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC New York (Upstate) Carrier National Government Services, Inc P.O. Box 4893, Syracuse, NY Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN New York (NYC Metro area, except Queens) Carrier National Government Services, Inc P.O. Box 4792, Syracuse, NY

11 Counties: Bronx, Columbia, Delaware, Dutchess, Greene, Kings (Brooklyn), Nassau, New York (Manhattan), Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN New York (Queens) Carrier National Government Services, Inc P.O. Box 4885, Syracuse, NY Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN North Carolina Carrier CIGNA Government Services Provider Enrollment, P.O. Box 25226, Nashville, TN Fiscal Intermediary Palmetto GBA Part A Provider Enrollment, 2300 Springdale Drive, Building One Camden, SC Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC North Dakota Carrier Noridian Administrative Services P.O. Box 6706, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6709, Fargo, ND (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA

12 Northern Carrier Palmetto GBA Provider Enrollment, P.O. Box 1667, Augusta, GA Mariana Fiscal Intermediary Palmetto GBA Provider Enrollment, P.O. Box 1508, Augusta, GA Islands Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Ohio Carrier Palmetto GBA Part B Provider Enrollment, P.O. Box , Columbus, OH Fiscal Intermediary National Government Services, Inc Part A Provider Enrollment, P.O. Box 7141, Indianapolis, IN Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Oklahoma Carrier TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX Fiscal Intermediary TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Oregon Carrier Noridian Administrative Services P.O. Box 6702, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6726, Fargo, ND Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN Pennsylvania Carrier Highmark Medicare Services Fiscal Intermediary Highmark Medicare Services Regional Home Health Intermediary Cahaba GBA, LLC , option 1 Provider Enrollment Services, P.O. Box , Camp Hill, PA , option 2 Provider Enrollment Services, P.O. Box , Camp Hill, PA (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA

13 Puerto Rico Carrier First Coast Service Options Provider Enrollment, P.O. Box 44021, Jacksonville, FL Fiscal Intermediary First Coast Service Options Provider Enrollment, P.O. Box 44021, Jacksonville, FL Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN Rhode Island Carrier Pinnacle Business Solutions Provider Enrollment, Post Office Box 34260, Little Rock, Arkansas Fiscal Intermediary Pinnacle Business Solutions Part A Provider Enrollment, P.O. Box 1418, Little Rock, AR Regional Home Health Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY South Carolina Carrier Palmetto GBA Part B Provider Enrollment (AG-310), P.O. Box , Columbia, SC Fiscal Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC South Dakota Carrier Noridian Administrative Services P.O. Box 6707, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6733, Fargo, ND Regional Home Health Intermediary Cahaba GBA, LLC (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA Tennessee Carrier CIGNA Government Services Provider Enrollment, P.O. Box 25226, Nashville, TN Fiscal Intermediary Riverbend Government Benefits Administrato Provider Enrollment - 3C, 730 Chestnut Street, Chattanooga, TN Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Texas Carrier TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX

14 Fiscal Intermediary TrailBlazer Health Enterprises, LLC Provider Enrollment, P.O. Box , Dallas, TX Regional Home Health Intermediary Palmetto GBA Part A Provider Enrollment (AG-331), P.O. Box , Columbia, SC Utah Carrier Noridian Administrative Services P.O. Box 6725, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6724, Fargo, ND Regional Home Health Intermediary Cahaba GBA, LLC (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA Vermont Carrier NHIC, Corp Provider Enrollment, P.O. Box 3434, Hingham, MA Fiscal Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Regional Home Health Intermediary National Government Services, Inc P.O. Box 4792, Syracuse, NY Virginia Carrier TrailBlazer Health Enterprises Provider Enrollment VA, P.O. Box , Dallas, TX Fiscal Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA Virgin Island Carrier First Coast Service Options Provider Enrollment, P.O. Box 44021, Jacksonville, FL Fiscal Intermediary First Coast Service Options Provider Enrollment, P.O. Box 44021, Jacksonville, FL Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN

15 Washington Carrier Noridian Administrative Services P.O. Box 6700, Fargo, ND Fiscal Intermediary Noridian Administrative Services P.O. Box 6720, Fargo, ND Regional Home Health Intermediary National Government Services, Inc Provider Enrollment, P.O. Box 7143, Indianapolis, IN West Virginia Carrier Palmetto GBA Palmetto GBA, Part B Provider Enrollment, P.O. Box , Columbus, OH Fiscal Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN Regional Home Health Intermediary Cahaba GBA, LLC (HHA) E. Court, Station 27, P.O. Box 14537, Des Moines, IA Wisconsin Carrier Wisconsin Physicians Service WPS-Medicare Provider Enrollment, P.O. Box 8248, Madison, Wisconsin Fiscal Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN Regional Home Health Intermediary National Government Services, Inc P.O. Box 7149, Indianapolis, IN Wyoming Carrier Noridian Administrative Services Medicare Part B, P.O. Box 6708, Fargo, ND Fiscal Intermediary Noridian Administrative Services Medicare Part A, P.O. Box 6734, Fargo, ND (HHA) Regional Home Health Intermediary Cahaba GBA, LLC E. Court, Station 27, P.O. Box 14537, Des Moines, IA

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