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Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R)

If you don’t use PECOS, use the revised CMS-855I (Medicare Enrollment Application - Physicians and Nonphysician Practitioners) to enroll or update your information. MACs will accept current and revised versions of the form through 10/31/2023. Starting 11/1/2023, you must use the revised form CMS-855I (05/23)

Form updates:

  • Combines the CMS-855I and CMS-855R paper applications and discontinues the CMS-855R
  • Moves physician assistant employer arrangements to the reassignment section
  • Recognizes physicians and nonphysicians who provide acupuncture services
  • Identifies compact licenses
  • Adds new physician specialties
  • Expands practice location types to include telehealth

Visit Medicare Enrollment for Providers & Suppliers for more information, including a CMS-855I instructional guide. To enroll and update your information more quickly and easily, use PECOS.

Visit our website for information located at:

Revised 10/16/2023