Dynamic List Information Dynamic List Data Form # CMS 855B Form Title Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers Revision Date 2026-04-29 O.M.B. # 0938-1377 O.M.B. Expiration Date 2028-12-31 Special Instructions N/A If you provide health care services in more than one state/territory and those states/territories are serviced by different MACs, complete a separate CMS-855B enrollment application for each MAC’s jurisdiction.
Clinics, group practices, and other Part B organizations can apply for enrollment in the Medicare program or make a change to their existing information using the Clinics/Group Practices and Other Suppliers (CMS-855B) application. A practical guide to completing the CMS-855B for Medicare enrollment, from gathering documents to submitting and what happens after approval. CMS can help your state prepare for the new Community Engagement requirements. Learn more Nondiscrimination in health The Enterprise Portal is a gateway that provides access to different Centers for Medicare & Medicaid Services (CMS) healthcare-based applications.
cms 855b, The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. Warning You are about to enter a CMS computer system. It may be used for official U.S. Government work only. Use by unauthorized persons, or for personal business, is prohibited and constitutes a violation of 18 U.S.C.
cms 855b, 1030 and other Federal laws. You have NO REASONABLE EXPECTATION OF PRIVACY while using this system. CMS.gov/Providers - Section of the CMS.gov website that is designed to provide Medicare enrollment information for providers, physicians, non-physician practitioners, and other suppliers.
