CMS Medicare Enrollment Application

Evan Anderson filed this request with the Centers for Medicare and Medicaid Services of the United States of America.


From: Evan Anderson

To Whom It May Concern:

This is a request under the Freedom of Information Act. I hereby request the following records:

The most recently completed Medicare Enrollment Application 855a forms (found here: for (1) Castlewood Treatment Center in St. Louis, Missouri, and (2) the Child Guidance Clinic in Springfield, MA.

The requested documents will be made available to the general public, and this request is not being made for commercial purposes.

In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 20 business days, as the statute requires.


Evan Anderson

From: Evan Anderson

Hi there,

Will you kindly acknowledge receipt of this request?

Thank you,

From: Centers for Medicare and Medicaid Services

Dear Requester:
We have received your inquiry.

Thank you

From: Centers for Medicare and Medicaid Services

Good Afternoon,

This request was received and is in process. An acknowledgment letter dated March 14, 2018 was sent to you. The CTRL# is 031420187016 and PIN PPYV. Please, see attached.

Thank You, and Have a Great Day!

From: Centers for Medicare and Medicaid Services

A copy of documents responsive to the request.