Form Cms-855i - Medicare Enrollment Application - Physicians And Non-Physician Practitioners Page 8

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SECtion 2: idEntifying inforMation
(Continued)
d. 1. Physician Specialty
Designate your primary specialty and all secondary specialty(s) below using:
P=Primary S=Secondary
You may select only one primary specialty. You may select multiple secondary specialties. A physician
must meet all Federal and State requirements for the type of specialty(s) checked.
Addiction medicine
Hematology/Oncology
Palliative Care
Allergy/Immunology
Hospice
Pathology
Anesthesiology
Infectious disease
Pediatric medicine
Cardiac Electrophysiology
Internal medicine
Peripheral vascular disease
Cardiac surgery
Interventional Pain
Physical medicine
Management
and rehabilitation
Cardiovascular disease
(Cardiology)
Interventional radiology
Plastic and
reconstructive surgery
Chiropractic
Maxillofacial surgery
Podiatry
Colorectal surgery
Medical oncology
(Proctology)
Preventive medicine
Nephrology
Critical care (Intensivists)
Psychiatry
Neurology
Dermatology
Psychiatry (geriatric)
Neuropsychiatry
Diagnostic radiology
Pulmonary disease
Neurosurgery
Emergency medicine
Radiation oncology
Nuclear medicine
Endocrinology
Rheumatology
Obstetrics/Gynecology
Family practice
Sports Medicine
Ophthalmology
Gastroenterology
Surgical oncology
Optometry
General practice
Thoracic surgery
Oral surgery (Dentist only)
General surgery
Urology
Orthopedic surgery
Geriatric medicine
Vascular surgery
Osteopathic Manipulative
Gynecological oncology
Medicine
Undefined physician type
Hand surgery
Otolaryngology
:__________________
(Specify)
Hematology
Pain Management
CMS-855I (07/11)
7

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