OMB control number
Medicare Enrollment Application for Physician and Non-Physician Practitioners
OMB 0938-1178 · HHS/CMS.
OMB 0938-1178
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-855I Changes of enrollment information | Form and Instruction |
| Form CMS-855I Revalidation of enrollment | Form and Instruction |
| Form CMS-855I Initial enrollment applications | Form and Instruction |
 CMS 855I - section mapping - 12072011.xlsx | Supplementary Document |
| CMS 855I - Revisons Spreadsheet - 12152011.xlsx | Supplementary Document |
 CMS-855I Supporting Statement Part A.docx | Supporting Statement A |
 Changes of enrollment information |
Form and Instruction |
| Revalidation of enrollment |
Form and Instruction |
| Initial enrollment applications |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201206-0938-006 | New collection (Request for a new OMB Control Number) | 2012-06-25 | Approved without change |