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National provider identification (NPI): The NPI number is a ten-digit identification number, associated with individual physicians, including both solo and group practices.
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BoredPractitioner 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.
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Malpractice Insurance (Certificate of Insurance): Medical malpractice insurance protects healthcare professionals against claims alleging their negligent acts caused injury to patients.
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DEA (federal) certificate and CDS (state)certificate
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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.
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Copy of highest level of education/ Diploma (required for non-MD’s, DO’s)
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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.
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IRS Form W-9
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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.
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Your Legal Entity
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IRS form CP575 or replacement letter 147C (verification of EIN)
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CLIA Certificate
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Business License
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Copy of office lease (required for therapy facilities)
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Letter of bank account verification (for Medicare enrollment)
