South Dakota Facilities/Entities: Update Your Information

Update Your Information

Update Wellmark with:

Changes in taxpayer identification numbers
Changes in demographic information (addresses, suite numbers, phone numbers, name changes, specialty changes, etc.)
Changes in practice status (closing, relocation, change of ownership, etc.)
The addition of a location
Changes in National Provider Identifier (NPI)

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

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 South Dakota Statewide Universal Facility Application (571KB).
To report a change in your NPI, use the NPI Notification Form and select the "Change to 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.