OMB control number

Medicare Enrollment Application for Physician and Non-Physician Practitioners (CMS-855I)

OMB 0938-1355 · HHS/CMS.

OMB 0938-1355

The primary function of the CMS-855I Medicare enrollment application for physicians and non-physician practitioners is to gather information from an individual provider or supplier that tells us who he/she is, whether he/she meets certain qualifications to be a Medicare health care provider or supplier, where he/she practices or renders services, and other information necessary to establish correct claims payments.

The latest form for Medicare Enrollment Application for Physician and Non-Physician Practitioners (CMS-855I) expires 2026-08-31 and is listed under ICR 202301-0938-009.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-855I Medicare Enrollment Application	Form and Instruction
Form CMS-855I Medicare Enrollment Application	Form and Instruction
Form CMS-855I Medicare Enrollment Application	Form and Instruction
Form CMS-855I Medicare Enrollment Application	Form and Instruction
Form CMS-855I Medicare Enrollment Application	Form and Instruction
Form CMS-855I Medicare Enrollment Application	Form and Instruction
Form CMS-855I Medicare Enrollment Application	Form and Instruction
CMS-855I - Revisions Spreadsheet - 07152025.xlsx	Supplementary Document
CMS 855I Supporting Statement.docx	Supporting Statement A
Currently Enrolled via CMS-855O now Enrolling as Individual Supplier	Form and Instruction
Currently Enrolled via CMS-855O now Enrolling as Individual Supplier	Form and Instruction
Voluntary Termination of Medicare Enrollment	Form and Instruction
Voluntary Termination of Medicare Enrollment	Form and Instruction
Reporting a Change	Form and Instruction
Reporting a Change	Form and Instruction
Switching Provider Type/MAC	Form and Instruction
Switching Provider Type/MAC	Form and Instruction
Revalidation	Form and Instruction
Revalidation	Form and Instruction
Reactivation	Form and Instruction
Reactivation	Form and Instruction
Initial Enrollment	Form and Instruction
Initial Enrollment	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202603-0938-001	Revision of a currently approved collection	2026-03-03
202301-0938-009	Reinstatement without change of a previously approved collection	2023-02-28	Approved without change
201807-0938-006	New collection (Request for a new OMB Control Number)	2018-08-02	Approved without change

OMB Details

Initial Enrollment

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-855i	Medicare Enrollment Application	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.