Medicare enrollment is required for providers and organizations that plan to furnish services to Medicare beneficiaries. This page explains the enrollment process from start to finish, including how to prepare, how to apply, what to expect after submission, and how requirements differ by provider type. It also provides key timelines, definitions, and resources that support a successful application.

• Before You Begin
• How to Apply
• Processing Timeframes
• Participation Options
• Requirements by Provider Type
  • At a Glance: Identify Your Provider Type (IRS Filing)
  • Organizations
  • Sole Owners
  • Partnerships
  • Sole Proprietors
  • Group Members
• After You Apply
• Contact Information

Before You Begin

Successful Medicare enrollment begins with proper preparation. Providers should confirm that they are eligible to enroll, obtain the appropriate National Provider Identifier (NPI), select the correct taxonomy code, and ensure that their PECOS and Identity & Access (I&A) accounts are ready for use. Completing these steps in advance ensures a smooth application experience.

Institutional providers (for example, hospitals and other facility-based providers) enroll in Part A. See the Part A Enrollment webpage for institutional enrollment information. Providers who furnish professional services must determine whether their specialty qualifies for Medicare Part B enrollment. A complete list of eligible specialties is available on the Eligible Specialties webpage. If a provider's specialty does not appear on this list, Medicare does not permit enrollment for that specialty. Providers who are unsure which taxonomy code applies to their practice can consult the X12 Health Care Provider Taxonomy Code Set, which assigns standardized classifications for every provider type.

All applicants must hold an NPI. Individual practitioners are required to obtain a Type 1 (individual) NPI, while organizations must obtain at least one Type 2 (organizational) NPI. The number of NPIs an organization uses is a business decision based on its operational structure. Whenever a provider's identifying information changes (including legal name, Taxpayer Identification Number (TIN), address, practice location, taxonomy code, authorized officials, or contact persons), the provider must update both NPPES and their Medicare enrollment record within 30 days.

Providers who apply electronically will complete their enrollment through internet based PECOS. All PECOS users must sign in using their own individual I&A credentials. These credentials define each user's authorized access level and determine what Medicare enrollment information they may view or modify. Tutorials, checklists, and detailed guidance are available on the PECOS webpage to help providers understand system access and documentation requirements.

Providers who plan to furnish Part B services in a Critical Access Hospital (CAH) under Method II must reassign their benefits to the CAH's PTAN and NPI. Providers enrolling solely to order, certify, or prescribe (without submitting Medicare claims) should review the Ordering, Certifying, and Prescribing guidance before beginning their application.

How to Apply

Providers may submit Medicare enrollment applications electronically through PECOS or by using the appropriate CMS paper forms. Internet based PECOS is the recommended method because it allows applicants to upload documents, verify information in real time, and electronically sign the certification statement. Providers who cannot submit electronically should complete the paper forms available on the Forms webpage and should ensure they are using the most current version, as any out-of-date forms will be returned and delay the enrollment process.

Processing Timeframes

The time required to process a Medicare enrollment application varies depending on whether the application is submitted electronically or via paper and whether an onsite visit is required. The following table reflects standard processing times.

Processing timeframes begin when Noridian receives a complete application. If the application is missing information, contains errors, or requires clarification, Noridian will issue a correction request or request for information (RFI). When an RFI is issued, processing is delayed until the requested information is received and reviewed, and the additional time needed to resolve the RFI is not included in the standard timeframes shown below. Submitting all required forms and supporting documentation with accurate, up-to-date information helps avoid RFIs and reduces processing delays.

Participation Options

Organizations, sole owners, and sole proprietors must decide whether they will enroll as participating or nonparticipating providers. Participating providers agree to accept Medicare approved amounts as full payment for covered services and accept assignment on all claims. This arrangement ensures consistent reimbursement but may limit certain billing choices.

Nonparticipating providers may decide on a claim by claim basis whether to accept assignment. When they do not accept assignment, they may charge beneficiaries up to the applicable limiting charge. Providers should compare the Medicare Physician Fee Schedule and any other relevant fee schedules to understand how participation status will affect their reimbursement.

Requirements by Provider Type

Medicare enrollment requirements differ depending on the provider's business structure. The following descriptions explain how each provider type is defined, which applications are required, and what important considerations apply.

At a Glance: Identify Your Provider Type (IRS Filing)

Not sure which provider type applies to you? Your business structure often aligns with how you file federal taxes. Use the guide below as a quick reference. Please note that tax situations can vary, confirm with your tax professional if you are unsure.

Note: This is a quick reference only. Your Medicare enrollment category is based on your legal business structure and enrollment scenario (for example, whether you are enrolling as an entity vs. reassignment to a group), which may not always match tax filing in every situation.

Organizations

An organization consists of two or more owners and must obtain at least one Type 2 NPI. Organizations bill Medicare using an Employer Identification Number (EIN) and may be sold or transferred. The appropriate application for organizations is the PECOS enrollment, supported by CMS‑855B for enrollment details, CMS‑588 for EFT setup, and CMS‑460 if electing participation. Organizations must include all directors, board members, and managing employees. At least one rendering provider must be associated with the organization, and those individuals must submit or update a CMS‑855I as needed.

Sole Owners

A sole owner is a business with one owner that is set up as a separate legal entity, most commonly a Professional Corporation (PC), Professional Association (PA), or certain types of LLC structures.

• NPI: You generally need both a Type 1 NPI (for you as an individual) and a Type 2 NPI (for the business).
  • Exception: A Type 2 NPI is not needed for an LLC that is not treated as a corporation. If your LLC is filing as an S Corporation, it is treated as a corporation for this purpose.
• Billing: Claims are billed using the business's EIN, and the business may be sold.
• How to apply: Enroll through PECOS using CMS-855I and CMS-588. If electing participation, also submit CMS-460.
• Include required documents such as diplomas, certifications/licenses, IRS documentation (as applicable), and EFT documentation/materials.

Partnerships

A partnership consists of two or more individuals or entities that jointly carry on a business for profit. Partnerships must obtain at least one Type 2 NPI and use an EIN for billing. They may be sold. Enrollment is completed through PECOS using CMS‑855B, CMS‑588, and CMS‑460 if applicable. The application must list all partners and managing employees and must include IRS verification and EFT documentation. Partnerships must have at least one rendering provider who submits or updates a CMS‑855I.

Sole Proprietors

A sole proprietor and the business are legally the same entity. Sole proprietors use a Type 1 NPI and may bill using either their SSN or a non‑incorporated EIN. Because the business is not a separate legal entity, it cannot be sold except when classified as a Disregarded Entity. Sole proprietors enroll through PECOS using CMS‑855I and CMS‑588, with CMS‑460 if electing participation. Required documentation includes diplomas, certifications, and IRS documents when applicable.

Group Members

Group members are individuals who reassign their benefits to an organization or another individual under an established arrangement. These providers do not bill Medicare directly; instead, the group submits claims on their behalf. Group members complete PECOS enrollment using CMS‑855I. Group members must list all reassignments, PTANs, and NPIs tied to their services and attach all required supporting documentation.

After You Apply

Once Medicare completes its review, the provider will receive a written notification indicating whether the application has been approved, rejected, or denied. If additional information is required during processing, Noridian will send a request to the contact listed on the application, and the provider must respond within 30 days to avoid processing delays.

Approved providers will receive a Provider Transaction Access Number (PTAN), which appears in the approval letter. Billing may begin once Electronic Data Interchange (EDI) enrollment is completed through EDISS. If a provider no longer furnishes services in a particular state, they must submit an application to withdraw their enrollment for that location.

Any changes to enrollment information must be reported within 30 days to avoid revocation. CMS also requires providers and suppliers to complete revalidation every five years.

Contact Information

Providers who need assistance may contact Noridian by phone, email, fax, or mail. Additional self-service tools such as the IVR Guide are available for quick access to claims and enrollment information. The Help section includes features such as the site map, feedback form, and site tour. Links to Adobe Reader and Excel Viewer are available for accessing PDF and spreadsheet resources.