OMB control number

Medicare Enrollment Application for Physician and Non-Physician Practitioners

OMB 0938-1178 · HHS/CMS.

OMB 0938-1178

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-855I Changes of enrollment information Form and Instruction
Form CMS-855I Revalidation of enrollment Form and Instruction
Form CMS-855I Initial enrollment applications Form and Instruction
CMS 855I - section mapping - 12072011.xlsx Supplementary Document
CMS 855I - Revisons Spreadsheet - 12152011.xlsx Supplementary Document
CMS-855I Supporting Statement Part A.docx Supporting Statement A
Changes of enrollment information Form and Instruction
Revalidation of enrollment Form and Instruction
Initial enrollment applications Form and Instruction

All Historical Document Collections

201206-0938-006

2012-06-25