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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).
Medicare Part B (Medical Insurance) Be age 65 or older; Be a U.S. resident; AND. Be either a U.S. citizen, OR. Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.
Your birth certificate or other proof of birth. Proof of United States citizenship or legal residency, such as a passport.
your original birth certificate or a copy thats been certified by the issuing agency, such as the state you were born in. if you dont have a record of your birth, other documents to prove your age, such as your immunization records, school records, state census records, insurance records, or medical records.
Fill out form CMS-40B. Send the completed form to your local Social Security office by fax or mail.
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CMS 855B. Form Title. Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers.
To apply for Medicare, youll need: Your Social Security Card. Your original birth certificate. Proof of U.S citizenship or legal citizenship status documentation if you were not born in the U.S. A copy of your W-2 form.
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.) Call Social Security at 1-800-772-1213.

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