CMS 855B--Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers
http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855b.pdf
Form 855B is completed by the following suppliers:
--	 Ambulance Service Supplier	
--	 Mammography Center
--	 Ambulatory Surgical Center	
--	 Mass Immunization (Roster Biller Only)
--	 Clinic/Group Practice	
--	 Part B Drug Vendor
--	 Independent Clinical Laboratory 	
--	 Portable X-ray Supplier
--	 Independent Diagnostic Testing Facility (IDTF)
--	 Radiation Therapy Center
--	 Intensive Cardiac Rehabilitation Supplier