(423) 443-4525

Forms Library

IRS Forms

What is a CP575?  The CP575 is the confirmation letter that you get from the IRS when you obtain a Employer Identification Number – EIN or “Tax Id#” for a business.  To enroll with Medicare, you must provide a copy of this letter as proof of the legal name of the business.  If you do not have the original CP575, then you can request a replacement letter 147C to verify your EIN.  These two documents are the only documents that Medicare accepts as proof of your EIN.

Click here for an example of a CP575 To request a replacement letter 147C, you can call the IRS business center at (800) 829-4933. The hours of operation are 7:00 a.m. – 7:00 p.m. local time, Monday through Friday.  Allow 4-6 weeks for processing the request.

W-9, Taxpayer Identification Verification Form

Medicare Provider Enrollment Forms and Information

Listing of Medicare Intermediaries by State

Medicare Provider Enrollment Regulations

Taxonomy Codes
Explanation of taxonomy codes with link to a code crosswalk published by Medicare
Link to Washington Publishing for an interactive search of taxonomy codes

Medicare Enrollment Forms
CMS 855A Medicare Enrollment Application – Institutional Providers
CMS 855B Medicare Enrollment Application – Clinics/Group Practices and Certain Other Suppliers
CMS 855I  Medicare Enrollment Application – Physicians and Non-Physician Practitioners
CMS 855O Medicare Enrollment Application – For Eligible Ordering and Referring Physicians and Non-Physicians
CMS 855R Medicare Enrollment Application – Reassignment of Medicare Benefits
CMS 855SMedicare Enrollment Application – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
CMS 588 Electronic Funds Transfer (EFT) Authorization Agreement
CMS 460 Medicare participating physician or supplier agreement