- Determine if you will use PECOS or paper to enroll
- Enroll Using PECOS
- Enroll Using Paper
- Determine your Business Structure
- Individual (Group Member) Reassigning Benefits Only
- Individual Medicare Enrollment Private Practice (Sole Proprietor) via SSN
- Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN
- Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID
- Physician Assistant
- New Provider Corporation or Group (Multiple Owners)
- Ordering/Referring Provider Only
- Adding a New Reassignment of Benefits Using the CMS-855I
- Electronic Funds Transfer Agreement
- Medicare Participating Physician or Supplier Agreement
- Supporting Documents
Ordering/Referring Provider Only
Download CMS-855O.
- Complete sections 1, 2, 3, 4, 5, 6 and 8.
Note:
- Ordering and referring providers are only required to be enrolled in one state.
- Be sure to include supporting documentation for unlicensed resident, per MLN Matters Article SE18008: Provider Enrollment – Unlicensed Residents.
- A residency contract signed and dated by both an official of the institution and the resident physician
- A letter on institution letterhead confirming the applicant’s status as a resident physician, signed and dated by an official of the institution and containing at a minimum, the name of the applicant
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
J6 Mailing Address:
National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475
Interactive Voice Response:
877-908-9499
Contact Enrollment:
877-908-8476
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. CT
Form(s) you'll need:
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee
JK Mailing Address:
National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46207-7149
Interactive Voice Response:
877-869-6504
Contact Enrollment:
888-379-3807
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. ET
Form(s) you'll need:
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
J6 Mailing Address:
National Government Services, Inc.
P.O. Box 6474
Indianapolis, IN 46206-6474
Contact Enrollment:
855-834-5596
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. CT
9:00 a.m.–5:00 p.m. ET
*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
11:00 a.m.-3:00 p.m. CT
Form(s) you'll need:
CMS-855A - Medicare Enrollment Application form for Institutional Providers
CMS-588 - Electronic Funds Transfer (EFT) Authorization Agreement form
Helpful Resources
Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee
JK Mailing Address:
National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46206-7149
Contact Enrollment:
855-593-8047
Hours Available:
Monday–Friday
8:00 a.m.–4:00 p.m. ET
*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
Form(s) you'll need:
CMS-855A - Medicare Enrollment Application form for Institutional Providers
CMS-588 - Electronic Funds Transfer (EFT) Authorization Agreement form