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We are committed to providing excellent service to both you and your patients. One way we
do this is to be as accurate as possible in our directory listings and referrals. By
providing us with any changes to your information, you can help us to maintain that
accuracy.
Please send the following changes in writing. They can be submitted to us via fax or mail,
but should be on your office stationery.
- Retirement
- Disenrollment
- Tax Identification Number (TIN), either name or number, accompanied by the most recent copy of your W-9 form
- Address, other than typographical edits
- Deceased
- Practice, billing or mailing address
- Malpractice, on the malpractice factsheet
The following are data changes that may be submitted via online, fax or mail:
- Name
- Accepting or declining new patients
- Office contact information
- Typographical edits
- New or changed hospital affiliation
- Office admitting privileges
Mail: PHCS/PDM
Attn: PDM-General Maintenance
1100 Winter Street
Waltham, MA 02451
Fax: PHCS
Attn: PDM-General Maintenance
(781) 895-3414
Private Healthcare Systems: Online Provider Change Notification Form
Please feel free to call Member and Provider Services at (800) 950-7040 with any questions about
data changes.
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