CMS-855I · Form guide

Form 855I and the 855R reassignment

Physicians and other individual practitioners. You sign it. Enrollment Watch does not.

Individual future due dates are not in the public file. A TBD on a physician NPI is the expected result.

What the form is actually about

• Personal identifying information
• Reassignment to a group (855R)
• Practice locations

Returns we see when a package comes back

• 855R signed by the group instead of the individual
• A reassignment left on after the clinician left

Check the public NPI record before you type

The free lookup shows the NPI, the state, and which form to file. The paid check compares the address and specialty with the public NPI registry. It cannot see your PECOS screen.

Example NPI lookup · Form 855I