Completing the Medicare CMS-460 enrollment application
Medicare participating physician or supplier agreement
A participating provider is one who voluntarily and in advance enters into an agreement in writing to provide all covered services for all Medicare Part B beneficiaries on an assigned basis. To become a participating provider, complete and submit the Medicare Participating Physician or Supplier Agreement (CMS-460) application.
The chart below is designed to provide additional instructions on completing the enrollment application. Please make sure to follow the guidelines listed on the application.
Note: Once you complete the application, you can either upload the application on the Provider Enrollment Gateway or mail the application to us.
| Section of form | Helpful hints |
|---|---|
| Name and address of participant |
Information provided on this application must align with the corresponding enrollment application:
The name and address are required. |
| National provider identifier (NPI) | The NPI is required. |
| Signature of participant and date |
A signature and date are required:
|
| Title and office phone number | The title and office phone number are required. |
| Additional guidance |
Must be submitted:
Individual physicians and non-physician practitioners who reassign benefits to a clinic or group practice inherit the participating status established by the clinic or group practice. For more information, please refer to: |