Documents Checklist for Credentialing
- National provider identification (NPI): The NPI number is a ten-digit identification number, associated with individual physicians, including both solo and group practices.
- Practitioner License(s): An active medical license is required for every state in which you are practicing or intend to practice medicine. A list of previous or inactive medical licenses may also be requested.
- Malpractice Insurance (Certificate of Insurance): Medical malpractice insurance protects healthcare professionals against claims alleging their negligent acts caused injury to patients.
- DEA (federal) certificate and CDS (state)certificate
- Board Certification(s): This information is required by every credentialing committee. Board certification ensures that physicians are meeting the highest standards set by their peers practicing in a medical specialty. It represents specialty-specific training beyond medical licensure.
- Copy of highest level of education/ Diploma (required for non-MD’s, DO’s)
Updated CV: Make sure that you organized it chronologically and included crucial data like demographic, education and licensure, awards and honors, practice history and hospital affiliations, and peer-reviewed publications or presentations. - IRS Form W-9
- Current driver’s license: A passport or other government-issued identification is an acceptable alternative. A passport-sized professional photograph may be requested to present in the early stage of your application.
- Your Legal Entity
- IRS form CP575 or replacement letter 147C (verification of EIN)
- CLIA Certificate
- Business License
- Copy of office lease (required for therapy facilities)
- Letter of bank account verification (for Medicare enrollment)