• cv - Resume/CV
• ecfmg_certificate - ECFMG Certificate
• malpractice_coi - Liability Insurance
• npdb - National Practitioner Data Bank
• residency_diploma - Residency Diploma
• fellowship_diploma - Fellowship Diploma
• college_diploma - College Diploma
• ssn_card - Copy of SSN Card
• medical_diploma - Medical Diploma
• csr_certificate - Controlled Substance Registration (CSR) Certificate
• dea_certificate - DEA Certificate
• drivers_license - Driver's License
• background_check - Background Check
• profile_picture - 2" by 2" Profile Picture
• passport - Passport
• birth_certificate - Birth Certificate
• claims_disclosure - Claims Disclosure
• disclosure_attestation - Disclosure Attestation
• disclosure_question_supporting_document - Disclosure Question Supporting Document
• aanp_diploma - ANCC/AANP Certificate
• board_certification - Board Certification Diploma
• cpr_certificate - CPR Training Certificate
• license_copy - License Copy
• loq_document - IMLC Letter of Qualification (LOQ)
• w9_form - W9 Form
• signature - Signature
• signature_initials - Signature Initials
• application_release - Application Release
• caqh_signature - CAQH Signature
• caqh_signature_initials - CAQH Signature Initials
• attestation_signature - Attestation Signature
• military_service_document - Military Service Document
• exam - Exam
• cme_credits - CME Certificate
• primary_source_screenshot - Primary Source Screenshot
• biography - Biography
• additional_name_supporting_doc - Additional name document
• other - Other
• ofac - OFAC
• dmf - DMF
• medicaid_exclusions - Medicaid Exclusions
• caqh_state_app - CAQH State App
• npi_profile - NPI Profile
• work_authorization - Work Authorization
• supervisor - Collaborative Agreement
• completion_document - Proof of Enrollment
• collaborative_physician - Collaborative Physician
• telehealth_certificate - Telehealth Certificate
• federal_tort_claim_act_coverage - Federal Tort Claim Act Coverage
• letter_of_self_insurance_or_explanation_no_insurance - Letter of Self Insurance/Explanation of No Insurance
• provider_reference - Provider Reference
• state_release - State Release
• state_authorization - State Authorization
• hospital_letter - Hospital Letter
• etin - Electronic Transmitter Identification Number (ETIN)
• ppo_agreement - PPO Agreement
• obat_form - OBAT Form
• clia_certificate - CLIA Certificate
• admitting_practitioner_signature - Admitting Practitioner Signature
• prescriptive_arrangement - Prescriptive Arrangement

Generated from available request content types