Changes to staff/address/phone

Reporting most provider changes

To notify Priority Health of changes in your address, staff, tax ID number, or if you are opening or closing to new patients, follow these steps:

60 days or more before the change takes effect, complete and print a change notification form.

It must contain:

  • What is changing
  • The effective date of the change
  • Entity or tax ID number (EIN or TIN)
  • W-9, as applicable
  • NPI number and taxonomy designation (specialty type) that you will be using for billing
  • If an NPI type 2 change is requested, you must also supply NPI type 1 information

Email the form to Priority Health at ph-pelc@priorityhealth.com, or fax it to the number on the form.

Reporting retirement/termination

At least 90 days prior to your retirement or termination of contract with Priority Health, fax or email us a letter signed by the contract holder notifying us of the change.