ENROLLMENT FOR ELIGIBLE ORDERING, CERTIFYING AND ...

MEDICARE ENROLLMENT APPLICATION. ENROLLMENT FOR ELIGIBLE ORDERING, CERTIFYING . AND PRESCRIBING PHYSICIANS, AND OTHER. ELIGIBLE PROFESSIONALS. CMS-855O. SEE PAGE 1 TO DETERMINE IF YOU ARE COMPLETING THE CORRECT APPLICATION. AND FOR INFORMATION ON WHERE TO MAIL THIS COMPLETED APPLICATION. Form Approved DEPARTMENT OF HEALTH AND HUMAN SERVICES OMB No. 0938-1135. CENTERS FOR MEDICARE & MEDICAID SERVICES Expires: 01/20. WHO SHOULD COMPLETE AND SUBMIT THIS APPLICATION. Most physicians and ELIGIBLE professionals (as defined in section 1848(K)(3)(B) of the Social Security Act) enroll in the Medicare program to be reimbursed for the covered services they furnish to Medicare beneficiaries.

medicare enrollment application enrollment for eligible ordering, certifying and prescribing physicians, and other eligible professionals cms-855o

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