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- Click ‘Get Form’ to open the CMS 855B in the editor.
- Begin with Section 1, where you will indicate the reason for submitting this application. Check the appropriate box and complete all required sections.
- In Section 2, provide your identifying information including your Legal Business Name, Tax Identification Number (TIN), and National Provider Identifier (NPI). Ensure accuracy as discrepancies can delay processing.
- Proceed to Section 3 to report any final adverse legal actions. This section must be filled out completely if applicable.
- In Section 4, detail your practice location information. Include addresses where services are rendered and ensure they are accurate and up-to-date.
- Complete Sections 5 and 6 regarding ownership interest and managing control information. Provide details for all individuals or organizations with significant ownership.
- Attach all required supporting documentation as outlined in Section 12 before submitting your application through our platform.
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