Form · Enrollment

CMS-855B form (Medicare enrollment for clinics, groups, and suppliers)

What it is, who uses it, and field-by-field help. Publisher: CMS. Links checked October 23, 2026.

Quick answer

The CMS-855B is the Medicare enrollment application for clinics, group practices, and other suppliers. A group uses it, or PECOS, to enroll, revalidate, report changes, and accept reassignment from its practitioners. It requires a type 2 (organization) NPI and goes to your MAC.

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At a glance

Form: CMS-855B, Medicare Enrollment Application: Clinics/Group Practices and Other Suppliers
NPI: Type 2 (organization) NPI required
Online option: PECOS
Ownership: At least one owner, one managing employee, and one authorized official must be reported
Send to: Your designated MAC
Get the form: CMS-855B (PDF)

Who uses it

Group practices and clinics billing Medicare Part B
Independent labs, portable x-ray suppliers, and other Part B suppliers
Groups accepting or ending a practitioner's reassignment of benefits

Sections

Section 1. Basic information: Reason for the application: new enrollment, new tax ID, new MAC, revalidation, reactivation, change of information, change of ownership, or termination.
Section 2. Identifying information: Legal business name, tax ID, type 2 NPI, supplier type, and correspondence address. These must match NPPES and IRS records.
Section 3. Final adverse legal actions: Final adverse actions against the supplier.
Section 4. Practice location information: Each practice location with its PTAN (if issued) and NPI.
Section 5. Ownership and managing control: organizations: Every organization with 5 percent or more ownership, any partnership interest, or managing control.
Section 6. Ownership and managing control: individuals: Owners, managing employees, and authorized and delegated officials who are people.
Section 8. Billing agency: A billing company that submits claims for you, if any.
Section 12. Supporting documentation: Required attachments for your supplier type.
Section 15. Certification statement: Signed by an authorized official.

Questions

Does a solo practitioner use the 855B?

Usually the 855I. CMS says a sole owner who wants to add an authorized or delegated official uses the 855B instead.

What NPI does the 855B need?

A type 2 (organization) NPI.