Information Change Request
If you need to change existing demographic information, complete the Demographic Change Form to initiate the process. Some of these changes include:
- Legal Name
- NPI/Tax ID
- Office Physical Address/Telephone/Fax/Email/Hours of Operation (Note: When submitting changes, please indicate in the comments section if you are “adding a location” or “changing a location”.)
- Billing Address/Telephone/Fax/Email
- Credentialing Address/Telephone/Fax/Email
- Administrative/Correspondence Address/Telephone/Fax/Email
- Other Provider Updates
- Remove Provider from Group/Location
If you have completed a Demographic Change Form, you can check the status of your changes by entering the case number you received in your confirmation email in our Case Status Checker .
Tax ID Termination Request
Contracted providers or groups (excluding Par Agreement) requesting a Tax ID termination from a provider network, please contact the Network Services Department at (800) 567-8540.
- You may specify more than one change within your request when all changes relate to the same billing (Type 2) NPI.
Changes are not immediate upon request submission. Change(s) may take up to 30 business days. Provider Finder may take up to an additional 30 days to reflect the change(s). We thank you for your patience!
For the status of your professional contract application, or if you have questions, or need to make changes to an existing contract, please contact the Network Services Department at (800) 567-8540.