Fill out CMS-855I (Medicare Enrollment Application - Physicians) online
Form CMS-855I is the Medicare enrollment application for individual physicians and non-physician practitioners. It must be completed before a provider can bill Medicare for services. The form collects credentials, practice locations, NPI, tax identification, and billing arrangement information.
How to fill out CMS-855I (Medicare Enrollment Application - Physicians)
Select the reason for application
Indicate whether you are submitting an initial enrollment, reactivation, change of information, or revalidation. Check the appropriate box and complete only the sections relevant to your application type.
Enter identifying and credential information
Provide your legal name, date of birth, Social Security Number, NPI, state medical license number(s), DEA number, and specialty/taxonomy code(s). Include all required credential documentation.
Report practice locations and billing arrangements
List all practice locations where you will provide services to Medicare patients. Indicate your billing arrangement: whether you will bill directly or reassign your benefits to a group practice (using the group's TIN).
Complete background disclosures and sign
Disclose any final adverse actions (revocations, suspensions, exclusions, felony convictions) within the required timeframes. Sign the certification statement and submit all required supporting documents.
About CMS-855I (Medicare Enrollment Application - Physicians)
Who needs this form
Individual physicians (MDs, DOs), nurse practitioners, physician assistants, clinical social workers, psychologists, and other eligible practitioners who want to enroll in the Medicare program or reassign their Medicare billing rights to a group practice.
Where to submit
Submit to the Medicare Administrative Contractor (MAC) that handles provider enrollment for your practice location. The specific MAC depends on your state. Applications can be submitted electronically through PECOS (Provider Enrollment, Chain, and Ownership System) at pecos.cms.hhs.gov.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not completing all required sections (incomplete applications are returned)
- Using an incorrect or inactive NPI number
- Not reporting all practice locations where services are rendered
- Failing to report adverse actions or sanctions in the background section
Frequently asked questions
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Can I submit the CMS-855I application online?
Yes. CMS strongly encourages electronic enrollment through PECOS (Provider Enrollment, Chain, and Ownership System) at pecos.cms.hhs.gov. Electronic applications are processed faster than paper submissions. However, certain supporting documents may still need to be mailed or faxed to the MAC.
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