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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 Inpatient Psychiatric Facility Short-term Acute Care 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, 2019 for providers except HHAs and PHPs; between Oct. 1-Dec. 31, 2019 for HHAs and PHPs). Validation code...