The following DMEPOS enrollment information may be submitted: Certificates of Insurance, Licenses, NPI Letter, Responses to SACU Requests, Surety Bonds, and PAR Agreements.

To upload the documentation to the NPE West, 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 NPE West 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.

To become a participating supplier, please submit a completed Form CMS-460.To change your status to non-participating, submit a request on your company's letterhead signed by the company's authorized or delegated official as previously reported to the NPE West.

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 submit your documentation via Provider Enrollment, Chain and Ownership System (PECOS) or hardcopy submission to the NPE West for review.