Home
Forms Library
Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner

Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner 2025

Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner Preview on Page 1

See details

4.2 out of 5

38 votes

The document is an application form for non-physician health care practitioners to begin the enrollment process or update their demographics. It requires personal information, documentation such as diplomas and licenses, and details about collaborating physicians. The application must be faxed to a specified number and includes sections for various health care roles, office addresses, and attestations from both the applicant and collaborating physician.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to rapidly redact Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is a perfect editor for updating your documents online. Follow this straightforward guideline redact Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner in PDF format online at no cost:

Register and log in. Create a free account, set a secure password, and proceed with email verification to start managing your forms.
Upload a document. Click on New Document and choose the file importing option: add Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner from your device, the cloud, or a protected URL.
Make changes to the sample. Take advantage of the upper and left panel tools to edit Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner. Insert and customize text, pictures, and fillable areas, whiteout unneeded details, highlight the significant ones, and provide comments on your updates.
Get your documentation done. Send the form to other individuals via email, generate a link for faster file sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail added.

Discover all the benefits of our editor today!

See more Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner versions

We've got more versions of the Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner form. Select the right Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (22 Votes)
2021	4.2 Satisfied (22 Votes)
2021	4.9 Satisfied (35 Votes)
2020	4.2 Satisfied (38 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between Medicare 855I and 855O?

CMS-855I: For employed physician assistants (sections 1, 2, 3, 13, and 15). CMS-855R: Individuals reassigning (entire application). CMS-855O: All eligible physicians and non-physician practitioners (entire application). Same applications are required as those of new enrollees.

What is an 855I application?

Complete this application if you are an individual practitioner or eligible professional who plans to bill. Medicare and you are: Currently enrolled in Medicare to order and certify and want to enroll as an individual practitioner to submit claims for services rendered.

What is an 855B application?

What is the 855B? ❖ The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data.

Is 855R being discontinued?

CMS has discontinued the CMS-855R (Reassignment of Medicare Benefits) form and updated its CMS-855I provider enrollment form.

What is the Medicare 855I form for?

All physicians, as well as all eligible professionals as defined in section 1848(k)(3)(B) of the Social Security Act must complete this application to enroll in the Medicare program and receive a Medicare billing number.

What is Medicare form 855R?

❖ 855R. CMS form which establishes a reassignment of your right to bill the Medicare. program and receive Medicare payments.

What is a non physician practitioner certification?

A nonphysician practitioner (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly, rather than billing under a physician, in certain circumstances.

Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner 2025

Here's how it works

How to rapidly redact Application for Non-Physician Health Care Practitioner. Application for Non-Physician Health Care Practitioner online