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Application for an initial Medicare providerregistration - humanservices gov 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your personal details in the 'Applicant’s details' section. Include your name, date of birth, and contact information. Ensure accuracy as this information is crucial for correspondence.
- In the 'Qualifications' section, specify your allied health profession and provide relevant registration or membership details. Remember, a separate application is needed for each profession.
- Fill out the 'Practice address and email' section with your practice's physical location. This is essential for identifying where services are rendered.
- Complete the 'Bank account details' section to facilitate Electronic Funds Transfer (EFT) payments. Ensure that all provided bank information is accurate.
- Review all sections to confirm that you have answered every question and signed the form before submission.
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See more initial medicare provider versions
We've got more versions of the initial medicare provider form. Select the right initial medicare provider version from the list and start editing it straight away!
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4 Satisfied (32 Votes) |
Who is the CMS Form 855i the enrollment application 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.
Who is eligible for CMS enrollment?
A person must be age 65 or older; and. Be eligible for monthly Social Security or Railroad Retirement Board (RRB) cash benefits.
How long does it take to get credentialed with Medicare?
Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting.
How to register for Medicare for the first time?
Ways to sign up: Online (at Social Security) Its the easiest and fastest way to sign up and get any financial help you may need. (Youll need to create your secure my Social Security account to sign up for Medicare or apply for benefits.) Contact your local Social Security office.
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