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Update Your Information

When to Notify Us

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).

How to Notify Us

  • To report changes in your Address, Phone, Fax, Name, Tax ID, Organizational NPI, Specialty, Provider/Group Cancellation, Backup Physician Information, Practitioner Payment Authorization, complete the Provider Change Form. A completed W-9 Form leave site 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 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 .

 



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