Last Modified: 12/1/2020
Location: FL, PR, USVI
Business: Part A, Part B
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
Community mental health centers should use the enrollment application form for institutional providers: CMS-855A
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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.