Internet Based PECOS Application Have your NPI available, also have your User ID & Password for the NPPES System. If you do not have these available you may call 1-800-465-3203. They will be able to assist you. Read the documents that are available about Internet-based PECOS at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/InternetbasedPECOS.html After you have completed and submitted your enrollment. Print the Certificate of Statement. Print, sign & date the certificate statement, mail to the Medicare Contractor (the address should have been displayed to you) in with any supporting documentation .

Paper Based PECOS Application Go to CMS forms page www.cms.hhs.gov/cmsforms , print and complete the CMS-855I (if you reassign benefits to a clinic or group practice other than your own, complete a CMS-855R as well) You will need your NPI number to fill out the CMS-855 (and *CMS-855R), if you need assistance with your NPPES Enumerator, User ID and password, contact the NPI Enumerator at 1-800-465-3203. Once you have completed the CMS-855 and (*CMS-855R), sign , date and mail (the address is provided on the form) with any additional required documentation. Once your address is received they will begin to process your enrollment, if any further information is needed they will contact you. (* if you reassign benefits to a clinic or group practice other than your own, complete a CMS-855R as well)