Home Care | 800-862-2166

PECOS Pre Enrollment Checklist

Before you begin registration in the Provider Enrollment, Chain and Ownership System (PECOS), make sure you have all of the information Centers for Medicare and Medicaid Services (CMS) requires. The checklist below details all of the information and documents you will need to complete enrollment successfully.

Pre-Enrollment Checklist

  • National Provider Identifier (NPI)
  • National Plan and Provider Enumeration System (NPPES) ID & Password
  • Personal Identifying Information:
    • Legal name
    • Date of birth
    • Social Security number
  • Schooling Information:
    • School name
    • Graduation year
  • Professional License Information:
    • Medical license number
    • Original effective date
    • Renewal date
    • State issued
  • Certification Information:
    • Certification number
    • Original effective date
    • Renewal date
    • State issued
  • Specialty/Secondary Specialty Information
  • Drug Enforcement Agency (DEA) Number
  • Information About Final Adverse Actions (if applicable)
  • Practice Location Information
    • Medical practice location
    • Special payment information
    • Medical record storage information
    • Billing agency information (if applicable)
    • Any federal, state, and/or local professional licenses, certification and/or registrations required for practice
  • Electronic Funds Transfer Documentation