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Last Modified: 6/19/2018 Location: FL, PR, USVI Business: Part A, Part B

Clinical psychologist -- enrollment application

Q: I am a clinical psychologist. Do I need to complete a special Medicare enrollment application?
A: If you are a clinical psychologist or a psychologist who bills independently, you have two options:
Note: PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the internet.
Complete and mail the Physicians and non-physician practitioners enrollment application form: CMS-855I external pdf file.
Note: Community mental health centers should use the enrollment application form for institutional providers: CMS-855A external pdf file.
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