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1. REQUISITION NO.SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS OFFER OR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 2. CONTRACT NO.3. AWARD/EFFECTIVE AVERAGE 1 OF4. ORDER NO.5. SOLICITATION NUMBER6.
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Form 855 is a health care provider enrollment application used by entities seeking to enroll in Medicare. The designation 'm street suite' typically refers to the administrative office where the form is processed or the location associated with the provider.
Medicare providers and suppliers, including physicians, non-physician practitioners, and facilities that want to participate in Medicare programs must file Form 855.
To fill out Form 855, applicants should gather necessary information such as facility details, ownership information, and identification numbers, then complete the form according to the CMS instructions, ensuring all sections are accurately filled out before submission.
The purpose of Form 855 is to collect information necessary for Medicare to enroll health care providers and suppliers, ensuring they meet the legal and regulatory requirements to provide services to Medicare beneficiaries.
Form 855 requires reporting of basic identifying information, ownership and control disclosures, practice locations, and the type of services provided.
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