Your application can be reviewed as soon as it’s complete. We’ve included a handy application checklist below of necessary items.
- Completed and Signed Online Application form
- Completed and Signed Physician Participation Agreement (PPA)
- Curriculum Vitae/Resume
- Copy of your CAQH Summary page
- Current MA state medical license
- Current Federal DEA Registration Certificate – To apply for a DEA registration or to obtain a copy of your certificate, contact the Regional Office of the Drug Enforcement Administration, 50 Staniford Street, Suite 200, Boston, MA 02114 or call (617) 557-2200.
- Current State Controlled Substances Certificate – To apply for a Mass. Controlled Substances number or to obtain a copy of your certificate, contact the Department of Public Health, Division of Food and Drugs, 99 Chauncy Street, Boston, MA 02111 or call (617) 983-6700.
- Current Professional Liability Insurance Facesheet – A copy must be obtained from your individual carrier and/or your agent and must have your name on it, the dollar amount you are covered for, and the dates your malpractice insurance coverage is effective.
- Copy of Board Certification
- Valid Photo ID or Passport
Download a copy of this checklist as a PDF.
