Get Medicare Cms855i 2011
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How to fill out the Medicare CMS855I online
The Medicare CMS855I is a crucial form for physicians and non-physician practitioners seeking enrollment in the Medicare program. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently.
Follow the steps to complete your Medicare CMS855I application online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by reviewing Page 1 to ensure you are completing the correct application based on your needs.
- Fill out Section 1, which includes your basic information such as your Medicare Identification Number and your NPI.
- Complete Section 2, providing identifying information including your name, date of birth, social security number, and correspondence address.
- If applicable, finish Section 3 by disclosing any final adverse actions or convictions you might have.
- In Section 4, enter your practice location information, ensuring your address is specific and not a P.O. Box.
- Complete Sections 5 through 12 as applicable; these sections may not pertain to you depending on your situation.
- Fill out Section 13 with a contact person’s information for Medicare to reach out regarding your application.
- Review Section 14 to understand the penalties for falsifying information.
- Certify and sign Section 15 to affirm that all information provided is true and complete.
- Gather and attach any supporting documentation as indicated in Section 17.
- Once completed, you can save your changes, download, print, or share the form as necessary.
Start filling out your Medicare CMS855I application online today for a smooth enrollment process.
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