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Last Modified: 9/19/2018 Location: FL, PR, USVI Business: Part B

Sole proprietor versus a sole owner

Q: What are the differences in completing Section 4 of a CMS-855I application for a sole proprietor versus a sole owner?
A: Sole Proprietorship - Section 4F of the CMS-855I is completed with the employer identification number (EIN). The instructions in this section state, “if you are a sole proprietor and you want Medicare payments to be reported under your EIN, list it below.” Only one national provider identifier (NPI) number is needed for the provider. Sole proprietors do not complete section 4A.
Sole Ownership - Section 4A of the CMS-855I is completed with the tax identification number (TIN). If anything is listed in section 4A, a separate NPI number must be obtained for the group number that will be assigned and listed in section 4A. The individual’s NPI number and information must be listed in section 4C.
CMS recently made available a document that will assist physicians and non-physician practitioners in completing the CMS-855I form titled Medicare Provider Enrollment of Individuals (Physicians and Non-Physician Practitioners) external pdf file. Scenarios 2a, 2b, 3 & 4 are very helpful in determining if you are a sole proprietor or sole owner.
Source: The Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) publication 100-08, chapter 15 external pdf file
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