PEPPER Resources Portal
Please complete the following fields to access your PEPPER. A provider’s PEPPER is only available to
that individual provider’s Chief Executive Officer, President, Administrator, Compliance Officer,
or Quality Assurance/Performance Improvement Officer.
The PEPPER Team is committed to ensuring and maintaining the confidentiality of each provider’s PEPPER.
Likewise, all recipients of PEPPER are expected to maintain and safeguard the confidentiality of privileged data or information.
I certify that I am the:
CEO
President
Administrator
Compliance Officer
Quality Assurance/Performance Improvement Officer
of this health care provider and further certify that I have the actual authority to receive PEPPER and all other confidential information concerning this health care provider. If a provider does not have a management position with any of these titles, the person who has the authority to make decisions on behalf of the organization should check the box for the title that best describes their position.
First Name
Last Name
Provider Name
Email
Provider City
Provider State / Territory
Northern Marianas Islands
Puerto Rico
Virgin Islands
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Confirm Email
Provider Type
Skilled Nursing Facility
Hospice
Inpatient Rehabilitation Facility
Partial Hospitalization Program
Long-term Acute Care Hospital
Home Health Agency
Critical Access Hospital
CMS certification number
(also referred to as Provider Number or PTAN)
Enter either a Patient Control Number *or* a Medical Record Number (found at form locators 03a or 03b on the UB04 claim form) from a claim of a traditional fee-for-service Medicare beneficiary who received services during the specified time period (“from” or “through” date between July 1-Sep. 30, 2018 for providers except HHAs and PHPs; between Oct. 1-Dec. 31, 2017 for HHAs and PHPs).
Validation code