Physician Credentialing Checklist

Medical degree diploma (MD or DO) Required

Current state medical license (all states where practicing) Required

DEA certificate (current and valid) Required

NPI number confirmation Required

CAQH ProView profile (completed and attested) Required

Board certification or eligibility letter Required

Current malpractice insurance certificate (face sheet) Required

Curriculum vitae / resume (up to date, no gaps) Required

Professional references (minimum 3 peer references) Required

Hospital privileges letter (current facility affiliations) Required

Work history documentation (past 10 years) Required

ECFMG certificate (if international medical graduate) Optional

CPR / BLS certification (current) Required

Government-issued photo ID (driver's license or passport) Required

Signed attestation questionnaire Required

Proof of professional liability coverage (tail coverage if applicable) Required

Residency and fellowship completion certificates Required

CDS certificate (state controlled substance license, if applicable) Optional

W-9 form (completed and signed) Required

Practice location details (address, phone, fax, hours) Required