US · guidance
CMS Pub. 100-08, ch. 10, § 10.3.1.3
Form CMS-855I – Medicare Enrollment Application for Physicians
and Non-Physician Practitioners
(Rev. 12639; Issued: 05-16-24; Effective: 06-17-24; Implementation: 06-17-24)
This application should be completed by physicians and non-physician practitioners who render
Medicare Part B services to beneficiaries and, as applicable, wish to reassign their benefits under
§ 424.80. (This includes a physician or practitioner who (1) is the sole owner of a professional
corporation, professional association, or limited liability company and (2) will bill Medicare
through this business entity.)
History
(Rev. 12639; Issued: 05-16-24; Effective: 06-17-24; Implementation: 06-17-24)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b48f4b5ff483219b7ac597bb8158f717df18dd5f3c761d1e8c21cfee90a14190
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