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Credentialing Application
Once you complete this form, I will email you with next steps
How is your business set up?
Sole Proprietorship
LLC
PLLC
S-Corp
Professional Corporation (PC)
None of these/unsure
Do you have a Type 2 NPI?
Yes
No
I don't know
Do you have a CAQH application
Yes
No
I don't know
Do you have liability insurance?
Yes
No
How many practitioners are you looking to credential?
Just myself
2
3
4
5
>5
Do you see patients in-person at a verifiable office location?
Yes
No
If you're applying to a closed network, have you applied previously?
Yes
No
I have reviewed the prices for Dan Feldman's credentialing Program
Yes
No
Submit
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