Group Practice Medicare Enrollment: CMS-855B Guide

Group practice Medicare enrollment uses the CMS-855B — the organization enrollment form. This guide covers the full process for group practices specifically, including the organizational requirements, enrollment steps, and the ownership/managing control disclosure that trips up many practices.

For the full CMS-855B form guide including all applicable organization types: CMS-855B overview →

What makes a group practice

Under Medicare, a “group practice” is two or more physicians (or eligible practitioners) who provide services under a shared organizational structure and bill Medicare under a shared organizational NPI and EIN.

Requirements for group practice Medicare enrollment:

• Two or more individually enrolled (or simultaneously enrolling) eligible practitioners
• A legal business entity with an EIN
• A Type 2 NPI for the organization
• A physical practice location (no P.O. Boxes, virtual offices, or home addresses)
• An authorized official with legal authority to bind the organization

A solo practitioner billing under their own individual NPI is not a group practice for Medicare purposes, even if they have a business entity. They can choose to bill as a group (via CMS-855B) or as an individual (via CMS-855I).

Before the CMS-855B: what to set up first

1. Establish your legal entity Form your legal business entity (LLC, PLLC, PC, partnership) and obtain an EIN from the IRS. The IRS CP-575 letter confirming your EIN and legal name is required documentation.

2. Register your Type 2 NPI Register the organization’s NPI in NPPES with your legal business name and the appropriate specialty taxonomy. Type 2 NPI guide →

3. Ensure each provider has an active Type 1 NPI Every physician or practitioner in the group needs their own individual NPI.

4. Ensure each provider is (or will be) individually enrolled Each provider files CMS-855I either before or simultaneously with the group’s CMS-855B. The CMS-855R (reassignment) is filed after individual enrollment is approved.

Step-by-step: CMS-855B for a group practice

Step 1: Set up PECOS access An authorized official for the organization creates a PECOS I&A account and links it to the organization’s Type 2 NPI. PECOS account setup →

Step 2: Start a new organization enrollment in PECOS Log in as the organization’s authorized official. Select “Organization Enrollment” → enter the group’s Type 2 NPI.

Step 3: Organization identification

• Legal business name (must match IRS records exactly)
• EIN
• “Doing business as” name (if different)
• Organization type: Group Practice
• State and date of incorporation

Step 4: Practice location(s) Each physical location where providers see patients. For multi-site practices, list all locations. Each requires:

• Physical street address
• Phone and fax
• Specialty taxonomy for that location
• Designation as primary or non-primary

Step 5: Correspondence address Where CMS and the MAC mail all official communications. Keep this permanently current.

Step 6: Ownership and managing control (the critical section)

This section requires disclosure of:

All owners with 5%+ direct or indirect ownership interest: For each owner: name, address, SSN or EIN, ownership percentage, date ownership began.

All managing employees: For each: name, address, title, nature of authority. Managing employees include:

• Practice administrators with budget authority
• CEOs, COOs, CFOs
• Managing partners
• Any individual who exercises operational or financial control

Related organizations: Any organization in which an owner or managing employee of your group holds 5%+ ownership.

Step 7: Adverse legal history All adverse actions against the organization and each owner/managing employee. Disclosures include: criminal convictions, Medicare/Medicaid exclusions, license revocations, prior Medicare sanctions.

Step 8: Upload supporting documentation

• IRS CP-575 letter (EIN confirmation)
• Articles of incorporation or organization agreement
• State business license
• Proof of professional liability insurance for the group

Step 9: Authorized official signature Must be signed by an individual with legal authority to bind the organization. For corporations: CEO, president, or authorized officer. For LLCs: managing member or manager. For partnerships: managing partner.

Step 10: Submit and track Submit in PECOS. Processing: 60–90 days typically. Track status in PECOS every 30 days.

After CMS-855B approval

1. Organization receives its PTAN
2. Each individual provider files CMS-855R to reassign benefits to the organization
3. Organization files CMS-588 for EFT
4. Configure billing system with the group’s NPI and PTAN
5. Individual providers’ services billed under the group NPI after reassignment is confirmed

⚠️ Risk flags

⚠️ Timing of reassignments. The CMS-855B approval and each CMS-855R reassignment happen on different timelines. The group can be approved, but a provider whose reassignment isn’t yet approved cannot have their services billed under the group NPI yet. Manage this timing carefully, especially for providers starting patient care before reassignment approval.

⚠️ Authorized official authority documentation. CMS may ask for documentation that the person signing has actual legal authority. Have board resolutions, operating agreements, or corporate officer documentation ready.

⚠️ Managing employees in multi-practice systems. If your group practice is part of a larger network where administrative staff have cross-entity authority, the managing employee disclosure may be broader than expected. Get legal review of who qualifies as a managing employee in your structure.

Processing timeline

Related pages

• CMS-855B — Full Application Guide
• CMS-855R — Reassignment of Medicare Benefits
• Organizations Overview
• NPI for Group Practices
• Reassignment of Benefits — How It Works

Questions about your group practice enrollment? Ask Mae → Free Metolius Health enrollment audit →