Medicare Enrollment Requirements for Healthcare Providers & DME Suppliers

Enrolling in Medicare is a critical step for healthcare providers, group practices, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. Without proper enrollment, providers cannot bill Medicare, which often means lost revenue opportunities and compliance risks.

Whether you’re a physician, a group practice manager, or a DME supplier, knowing the rules, especially around practice location addresses, accreditation, and site visits, is essential for approval and long-term compliance.

Why Medicare Enrollment Matters

• Mandatory for participation: Without Medicare enrollment, providers and suppliers cannot serve Medicare beneficiaries or bill Medicare.
• Revenue impact: Medicare patients and members are a key segment across specialties and DME suppliers.
• Compliance requirement: Enrollment ensures providers and suppliers meet CMS regulations and can withstand audits or site inspections.

Physical Address Requirements for Medicare Enrollment

Medicare requires that all applicants list at least one physical location on their enrollment forms.

CMS Rules on Practice or Supplier Address

• No P.O. Boxes allowed as the official practice/supplier location.
• The address must be a street address where care or services are delivered, or where operations are based.
• For telehealth-only providers, CMS still requires a physical business office.
• For DMEPOS suppliers, the facility must have posted business hours, proper signage, and meet accreditation standards.
• All locations are subject to site verification visits by MACs or the National Supplier Clearinghouse (NSC).

Different Address Types in Enrollment

• Practice/Supplier Location Address: Mandatory physical site.
• Correspondence Address: For CMS communications (maybe a P.O. Box).
• Remittance Address: For Medicare payments (may differ from practice location).
• Billing Address: For billing agents or central offices.

Medicare Enrollment Applications: Which Form to Use?

Individual Enrollment (CMS-855I / PECOS)

• For physicians, nurse practitioners, physician assistants, and other licensed practitioners.
• Requires at least one physical practice address.
• Generates a PTAN (Provider Transaction Access Number).
• If billing under a group, must also file a CMS-855R to reassign benefits.

Group/Facility Enrollment (CMS-855B)

• For group practices, clinics, labs, ambulatory surgical centers (ASCs), and other facilities.
• Must list all physical practice/facility addresses.
• Each individual provider must still complete a CMS-855I enrollment, then be linked to the group’s 855B.
• Groups are responsible for maintaining accurate rosters of associated providers.

DMEPOS Supplier Enrollment (CMS-855S)

• For Durable Medical Equipment, Prosthetics, Orthotics, and Supplies suppliers.
• Requires a physical business location with posted hours and signage (no P.O. Boxes or virtual offices).
• Must maintain DMEPOS accreditation, liability insurance, and an active surety bond.
• Subject to mandatory site inspections by CMS or NSC.
• Common denial reasons: missing accreditation, expired surety bonds, unverifiable addresses.

Practical Guidance for Enrollment Success

1. Secure a Physical Location Early
   • Providers: Use a hospital, clinic, or leased suite if not yet established.
   • Groups: List all practice/facility sites upfront to avoid rejections.
   • DMEPOS suppliers: Ensure compliance with signage, business hours, and site accessibility.

2. Keep All Systems Aligned
   • Ensure addresses match across PECOS, CAQH, and payer applications.

3. Prepare for Site Verification
   • Providers: Ensure your office is operational and accessible.
   • DMEPOS suppliers: Be ready for NSC inspections with accreditation, posted hours, and proper documentation.

4. Stay Current on Revalidations
   • Medicare requires revalidation every 5 years for providers and every 3 years for DME suppliers.

Medicare Enrollment Comparison: Individual vs. Group/Facility vs. DMEPOS Supplier
Feature	Individual Enrollment (CMS-855I)	Group/Facility Enrollment (CMS-855B)	DMEPOS Supplier Enrollment (CMS-855S)
Who Uses It	Physicians, Nurse Practitioners (NPs), Physician Assistants (PAs), other individual practitioners	Medical groups, multi-specialty practices, clinics, labs, ASC facilities	Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers
Practice Location Requirement	Must list at least one physical practice address (no P.O. Boxes)	Must list all physical practice/facility addresses	Must list a physical facility location with posted hours (cannot be a P.O. Box, UPS box, or “virtual” site)
Correspondence Address	Optional – may be a P.O. Box	Optional – may be a P.O. Box	Optional – may be a P.O. Box
Remittance Address	Where Medicare payments/EFTs go (can differ from practice address)	Where group/facility receives payments	Centralized billing or supplier office (must be consistent with accreditation records)
Site Visit Requirement	Yes – MACs may verify listed location	Yes – each location subject to site verification	Yes – CMS or NSC conducts mandatory site visits to validate supplier compliance
Additional Requirements	NPI registration through NPPES	Must reassign billing rights to group Tax ID	DMEPOS accreditation, liability insurance, posted signage, and surety bond
Application Form	CMS-855I (PECOS online or paper)	CMS-855B (groups/facilities), plus CMS-855R for reassignments	CMS-855S (specific to DMEPOS suppliers)
Common Errors	Using a P.O. Box as practice address; not updating address after relocation	Failing to add new locations or link providers; inconsistent records in PECOS vs. CAQH	Submitting without proof of accreditation or surety bond; using virtual/PO box addresses
Best Practice	Keep NPI, CAQH, and PECOS addresses consistent	Maintain centralized log of providers and locations for quick updates	Ensure accreditation, bond, and insurance are active before submitting; prepare for site inspections

Pros & Cons of Using a Temporary Address for Medicare Enrollment

Pros (Providers & Groups)

• Allows providers employed or contracted at a hospital/clinic to start billing Medicare immediately.
• Meets CMS requirement for a physical, verifiable practice location at the time of enrollment.
• Useful when the provider won’t have their own office space for several months.

Pros (DMEPOS Suppliers)

• Having a temporary leased facility or shared medical office may allow a faster application start while awaiting a permanent site.
• Demonstrates to CMS that a supplier has a business presence (important for compliance).

Cons (Providers & Groups)

• Once the provider moves to a permanent office or suite, a CMS-855I Change of Information (or 855B for groups) must be filed.
• May trigger a site visit verification for the new location.
• Adds extra administrative steps and delays compared to enrolling directly with the permanent address.

Cons (DMEPOS Suppliers)

• Much stricter rules: CMS requires a permanent, dedicated DMEPOS business location with signage, posted hours, liability insurance, surety bond, and accreditation.
• Temporary or virtual offices, residential addresses, and P.O. Boxes are not acceptable. Using one will result in denial.
• Suppliers who change addresses after approval must re-file an 855S Change of Information and undergo another mandatory site inspection.

How TriumpHealth Helps

At TriumpHealth, we simplify Medicare enrollment for:

• Individual Providers (CMS-855I): Full support with PECOS setup and PTAN tracking.
• Group/Facility Enrollment (CMS-855B): Guidance on linking providers, maintaining rosters, and updating locations.
• DMEPOS Supplier Enrollment (CMS-855S): Assistance with accreditation, surety bond compliance, site readiness, and application submission.

Contact TriumpHealth today to learn how our experts manage every step, from initial application to revalidation, to eliminate errors, shorten timelines, and ensure approval. In addition to healthcare providers and group credentialing, we help DME suppliers evaluate their products, facility setup, and compliance documentation to create a customized plan for successful DME Medicare enrollment. For more details you can schedule a consultation, or call us at (888) 747-3838 x0, or email us at sales@triumphealth.com.

Disclaimer:

The content provided by TriumpHealth is for informational purposes only and does not constitute legal, medical, or financial advice. Regulations and payer requirements may change; please consult a qualified professional for guidance specific to your situation. Click here to review our full legal disclaimer.