CMS 855S Application Form

The CMS 855S application is available on the Centers for Medicare & Medicaid Services' (CMS) website.

View the website
to access the form and program instructions.

Contact NSC

Email National Supplier Clearinghouse

Contact a specific NSC department

Telephone: 866-238-9652

IVR: 866-238-9652

Address:

National Supplier Clearinghouse

Palmetto GBA, AG-495

P.O. Box 100142

Columbia, SC 29202-3142

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bid Program

JM Part A

JM Part B

JM Home Health & Hospice

MolDX

Railroad Medicare Providers

Railroad Medicare Beneficiaries

National Supplier Clearinghouse



DCSIMG