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Provider File Changes (GEN)
Providers are responsible for notifying the Provider Enrollment Department of any changes to their provider file. All changes must be submitted within 90 days of the change. Failure to do so can result in the deactivation of your Provider Transaction Access Number (PTAN). Changes must be submitted on the appropriate enrollment form, 855B, 855I, and 855R. Mail your completed enrollment form(s) to:
Upstate Medicare Division
Provider Enrollment / Maintenance
PO Box 5209
Binghamton, NY 13902-5209.
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