Medicare Provider Enrollment Forms
Official Medicare enrollment applications, EFT forms, participation resources, PECOS and revalidation information.
CMS-855I — Physicians & Non-Physician Practitioners
Download PDF Medicare enrollment application for individual physicians and non-physician practitioners.
CMS-855B — Clinics, Group Practices & Certain Other Suppliers
Download PDF Medicare enrollment application for clinics, group practices and certain organizational suppliers.
CMS-855A — Institutional Providers
Download PDF Medicare enrollment application for institutional providers.
CMS-855O — Ordering & Certifying Providers
Download PDF enrollment application for eligible professionals enrolling to order or certify Medicare items or services.
CMS-855S — DMEPOS Suppliers
Download PDF Medicare enrollment application for durable medical equipment, prosthetics, orthotics and supplies suppliers.
CMS-588 — Electronic Funds Transfer Authorization Agreement
Download PDF EFT authorization agreement used with Medicare provider enrollment.
CMS-460 — Medicare Participating Physician or Supplier Agreement
Access the Medicare participation agreement for physicians and suppliers.
PECOS — Medicare Enrollment Online
Use Medicare's online enrollment system for initial enrollment, changes and revalidation.
Medicare Revalidation
Review Medicare provider and supplier revalidation requirements and due-date information.
CMS Medicare Enrollment Applications Directory
Access the current CMS directory of Medicare paper enrollment applications and supporting forms.
Forms, portals and program requirements may change. Verify the current version and applicable requirements with the issuing organization before submission or use.