Catalogue › Nursing & Healthcare Support › General
PaidFillable AcroFormUnited States
Medicare Enrollment Application - Institutional Providers, Form CMS-855A (09/2024, OMB Exp. 09/30/2027)
Fillable PDF form with 1237 form fields over 72 pages. Category: Nursing & Healthcare Support › General.
| Format | PDF (AcroForm) |
|---|---|
| Pages | 72 |
| Form fields | 1237 fillable fields |
| Jurisdiction | United States |
| Field / type | Nursing & Healthcare Support › General |
| Version (last updated) | 2026-10-16 |
| Licence | US-gov-PD (checked 2026-10-16) |
| Attribution | Source: U.S. Centers for Medicare & Medicaid Services, Medicare Enrollment Application - Institutional Providers, CMS-855A (09/24, OMB 0938-0685, Exp. 09/30/2027), cms.gov (U.S. Government work, 17 U.S.C. 105). Prepared by FormSphere as a fillable AcroForm; not affiliated with or endorsed by CMS, HHS or Medicare. |
Please check this template for currency and for your local requirements before using it. It is a blank template, not legal advice and not a guarantee of compliance.