Updating your provider master information for PARD
This form can only be used to update the non-official contacts used only by Provider Audit and Reimbursement for informal cost report related items. If you need to change any of the key employees, officers, administrator, CFO, director, etc., or if you need to update the address, do not use this form, as CMS requires this information be communicated to the MAC via an 855A form with our Provider Enrollment department.