Documents needed for and individual:

Any/all practitioner License(s)

Malpractice Insurance (also known as the certificate of insurance)

Documents regarding any/all settled, dismissed and/or pending malpractice claims

DEA (federal) certificate

CDS (state) certificate(s)

Board Certification(s)

Diploma (must show your highest level of education (such as M.D., D.O, etc.)

Certificates of completion for all medical training (such as an internship, residency or fellowship)

CME certificates; and all letters for all current hospital privileges

A current copy of your CV (showing current employer, employment contact names, phone numbers and email addresses, if available)

A copy of the IRS Form W-9

A current copy of your driver’s license

A copy of any ECFMG Certificates (if you were educated in a foreign country)

A copy of your passport or any other citizenship documents (if born in another country)

Documents needed for a legal entity:

IRS form CP575 or replacement letter 147C (verification of EIN)

CLIA Certificate

Business License

To get started contact MY-APP-STAT at 877.587.8815 x 701 or by email at info@myappstat.com