Provider enrollment applications and forms
Eliminate the guess work
The enrollment application assistance tool removes the guesswork for providers trying to figure out which enrollment form to use, whether they are submitting an initial enrollment, a change of information, revalidation or even terminating their Medicare enrollment.
This tool offers tips to clarify what should be included in each relevant section of the appropriate enrollment form as well as what additional documentation is needed to complete the process.
Determine which CMS-855 form fits your enrollment needs. Access all CMS-855 forms: 855A, 855B, 855I, 855O, 855R, and 855S.
Participants agree to accept assignment for all covered services provided to Medicare patients. New physicians, practitioners, and suppliers may submit this form at the time of enrollment.
Find information about the Provider Enrollment, Chain and Ownership System (PECOS), the Centers for Medicare & Medicaid Services’ online enrollment process.
View basic form descriptions to assist you in determining which CMS-855 form to complete.
Providers are required to signup for electronic funds transfer (EFT) using a CMS-588 EFT form upon initial enrollment in the Medicare program or when changing enrollment information.
Medicare provider enrollment information for providers, physicians, non-physician practitioners, and other suppliers.
Enrolling online saves you time, view these steps to get started.
Find information on where to mail paper enrollment applications and forms.
An entity or individual who wishes to furnish mass immunization services - but may not otherwise qualify as a Medicare provider - may be eligible to enroll as a “mass immunizer.”
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.