Iowa Practitioners: Update Your Information

Update Your Information

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	Iowa Practitioners:

»	How the Process Works

»	Apply for Participation

»	Update Your Information

	Iowa Facilities/Entities:

»	How the Process Works

»	Apply for Participation

»	Update Your Information

	South Dakota Practitioners:

»	How the Process Works

»	Apply for Participation

»	Update Your Information

	South Dakota Facilities/Entities:

»	How the Process Works

»	Apply for Participation

»	Update Your Information

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Update Your Information

Update Wellmark with:

Changes in clinic affiliation
Changes in taxpayer identification numbers
Changes in demographic information (addresses, suite numbers, phone numbers, name changes, specialty changes, etc.)
Changes in practice status (retirement, relocation, etc.)
Addition of a location
Changes in National Provider Identifier

Wellmark will review your request and let you know within 30 days if further actions are necessary (such as a contract change).

To report changes in your address, name, specialty or Taxpayer ID, complete the Provider Change Form. A completed W-9 Form must accompany any Tax ID change.
To add a location, or to change both your Taxpayer ID and your address, complete the Professional Provider Application - S-5400 .
To report a change in your NPI, use the NPI Notification Form and select the "Change Existing Notification" option.
To check on the status of a request previously sent, call us at 1-800-708-1342 or 515-376-5100, or e-mail us at providercredentialing@wellmark.com . We will respond to your inquiry within 24 hours of receipt.

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