Change of Enrollment Information

Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)

OMB: 0938-1056

IC ID: 197901

Documents and Forms

Document Name Document Type
Form CMS-855(S) Change of Enrollment Information Form and Instruction
CMS-855(S) Medicare Durable Medical Equipment Supplier Enrollment Application CMS-855S Medicare Enrollment Application DMEPOS.pdf Form and Instruction
CMS-855-S Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers CMS- 855S - DMEPOS Supplier PECOS Screen Shots - Word - 508.pdf Form and Instruction