The following DMEPOS enrollment information may be submitted: Appeals,
Certificates of Insurance, Rebuttals due to deactivation, Licenses, NPI Letter, Responses to SACU Requests,Surety Bonds and PAR Agreement.
To upload the documentation to the National Supplier Clearinghouse, select the appropriate document type
from the dropdown box below and enter the required identifying information in the fields provided.
The documentation must be in PDF format. Ensure you include a copy of your current Liability Insurance Certificate,
listing the NSC as the Certificate Holder.
Do not submit a CMS-855S application or any changes of information with this Web form.
Any changes of information submitted with this form will not be processed. Refer to our
Change of Information Guide
on how to submit any other enrollment information that needs to be updated.
You can only submit documentation if you have a DMEPOS PTAN (active, deactivated or revoked).
If you do not have a PTAN, you will need to mail your documentation to the NSC for review.
If you do not have a PTAN, you will need to mail your appeal to the NSC.
(*) Red asterisk indicates a required field.