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Last Modified: 8/11/2010
Location: FL, PR, USVI
Business: Part A, Part B
Provider/supplier enrollment applications
Internet-based PECOS
Find information about the Centers for Medicare & Medicaid Services’ online enrollment process, the Internet-based Provider Enrollment, Chain and Ownership System 
(PECOS). If you are familiar with Internet-based PECOS, click here to log in.
(PECOS). If you are familiar with Internet-based PECOS, click here to log in.Paper enrollment applications
Medicare provider/supplier enrollment applications (i.e., CMS-855) may be found at http://www.cms.gov/CMSForms/CMSForms/list.asp#TopOfPage (Note: the provider enrollment Web page contains a link "All CMS Forms" and takes you to the main CMS Forms Web page, but does not link directly to each individual form.).
(Note: the provider enrollment Web page contains a link "All CMS Forms" and takes you to the main CMS Forms Web page, but does not link directly to each individual form.).The direct link for each Medicare provider/supplier enrollment application is shown below:
• CMS 855B for Clinics/Group practices and Certain Other Suppliers: http://www.cms.gov/CMSforms/downloads/cms855b.pdf 
• CMS 855I for Physicians and Non-Physician Practitioners: http://www.cms.gov/cmsforms/downloads/cms855i.pdf
• CMS 855S for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers: http://www.cms.gov/cmsforms/downloads/cms855s.pdf
Mail completed paper provider/supplier enrollment applications to:
Provider Enrollment
P.O. Box 44021
Jacksonville, FL 32231-4021
P.O. Box 44021
Jacksonville, FL 32231-4021
