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| Iowa Facilities/Entities: |
| South Dakota Practitioners: |
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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, name, specialty or Taxpayer ID, complete the Provider Change Form. A completed W-9 Form
 (250KB) 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 (477KB).
- 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 515-245-5100, or e-mail us at providercredentialing@wellmark.com
 . We will respond to your inquiry within 24 hours of receipt.
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