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On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. To learn more about this from Change Healthcare, please visit the Change Healthcare website or reach out to the contact center at 1-866-262-5342. More from Change Healthcare
On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. To learn more about this from Change Healthcare, please visit the Change Healthcare website or reach out to the contact center at 1-866-262-5342. More from Change Healthcare

Demographic Change

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What do you need to do? required *
(numbers only/without dash)
NPI must be 10 numbers

Location Address

(numbers only/without dashes)
(numbers only/without dashes)

Update Requested By

(numbers only/without dashes)

NPPES must be updated with the name change in order to process this request.

NPI must be 10 numbers

Practitioner Current Name

Practitioner New Name

Update Requested By

(numbers only/without dashes)
NPI must be 10 numbers

Practitioner Name

Update Requested By

(numbers only/without dashes)
NPI must be 10 numbers
(numbers only/without dash)

Location Address

Location Office Hours

Please specify if Closed, Open 24 hours, or Enter hours in 15 minute increments, ex. 9:15 AM.

Update Requested By

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Race/Ethinicity
Please explain Other Race/Ethnicity
NPI must be 10 numbers

Practitioner Name

Update Requested By

(numbers only/without dashes)
(numbers only/without dash)
NPI must be 10 numbers

Location Address

Telehealth Participating?
E-Consult?
Synchronous live visit?
Remote patient monitoring?
Electronic Health Record?