Form Cms-855b - Medicare Enrollment Application - Clinics/group Practices And Certain Other Suppliers

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MediCare enrollMent aPPliCation
Clinics/group Practices
and Certain other Suppliers
CMS-855B
See Page 1 to deterMine if you are CoMPleting the CorreCt aPPliCation.
See Page 2 for inforMation on where to Mail thiS aPPliCation.
See Page 35 to find a liSt of the SuPPorting doCuMentation that MuSt Be
SuBMitted with thiS aPPliCation.

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Parent category: Medical