Participant Information

Attention Physicians:

There are two (2) prerequisites for joining Foothill Accountable Care Medical Group:

1. You must be exclusive to one ACO in a given performance year.

2. Your billing Tax Identification Number (TIN) must be enrolled in Medicare. To enroll your TIN with Medicare, please submit an online application on the Medicare Provider Enrollment, Chain and Ownership System (PECOS) website at https://pecos.cms.hhs.gov or if you prefer to mail your Medicare Enrollment Application, please go to www.cms.gov and print the paper application entitled "Medicare Enrollment Application, Physician and non Physician Practitioner"- Form 855I (individual form), or Form 855B (group form), complete the appropriate application form and if you are seeking electronic payments, print and complete CMS Form 588 – Electronic Funds Transfer Authorization Form and mail the form(s) to:

Noridian Healthcare Solutions
Provider Enrollment
P.O. Box Part B 6775
Fargo, ND 58108-6775

If you have any questions, please contact Noridian Part B Provider Contact Center at (855) 609-9960.

Centers for Medicare and Medicaid Services

Medicare Service Center: 800-MEDICARE (800-633-4227)

Medicare Service Center TTY: 877-486-2048