Documents Library

nCred Forms

Initial Credentialing Information Form

Practitioner Add-on Form (add a new practitioner to your credentialing subscription)

IRS Forms

W-9
CP575 (click for an example) 
A CP575 is a verification of your EIN that is produced at the time your EIN is issued.  The form cannot be reproduced by the IRS.  If you have lost your CP575, you can call the IRS and request letter 147C which is a verification of your EIN and legal business name by the IRS.  Either a CP575 or a letter 147C is required by Medicare when enrolling as a group/supplier.

IRS Telephone Assistance for Businesses:
Toll-Free, 1-800-829-4933
Hours of Operation: Monday – Friday, 7:00 a.m. – 10:00 p.m. your local time (Alaska & Hawaii follow Pacific Time).

Enrollment Forms

Medicare

List of Medicare Intermediaries by State

CMS 855I - Individual Medicare enrollment application
CMS 855B - Group / Supplier enrollment application
CMS 855R - Medicare re-assignment of benefits
CMS 855S - DMEPOS Supplier application
CMS 855O - Individual physicians and non-physicians for ordering and referring items or services
CMS 855A - Institutional Providers
CMS 588 - Electronic Funds Transfer (EFT) Authorization
CMS 460 - Medicare participation election