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Posting Date: 04/29/2021
Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN
Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN Download CMS-855I: Complete sections: 1, 2, 3, 4, 6, 8, 12, 13 and 15B. Notes: Be sure to complete section 4, 4A, 4A3 (enter employer identification number) 4B, [...]
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Posting Date: 05/07/2019
Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID
Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID Download CMS-855I: Complete sections 1, 2, 3, 4, 6, 8, 12, 13 and 15. Notes: Corporation structures: examples are PA, PC, LLC, PLLC, Inc., etc. Be sure to complete [...]
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Posting Date: 05/07/2019
Physician Assistant
Physician Assistant Download CMS-855I Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit the required supporting documents including the NCCPA and diploma. Reviewed 6/13/2024
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Posting Date: 11/08/2019
Supporting Documents
Supporting Documents Attach required supporting documentation for individuals or organizations. Submit all applicable documents: CMS-588 EFT Authorization Agreement and voided check or bank confirmation letter IRS document confirming your [...]
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