Join as Provider
The process of becoming a provider in our network has a few steps to ensure that our network maintains its high quality of service.
After having received the questionnaire, we will create a record in our system and send back the Provider Portal user information.
After having received the portal information, the applicant will need to log in and create a secure password. The application form in the portal must be submitted with the required documents within 10 business days of receipt of the portal user information.
Once submitted, the application will be Peer Reviewed by a panel (usually the first Tuesday of every month). If approved, the applicant becomes a part of the network and will receive a contract to sign.
Those documents include:
Current Curriculum Vitae (CV) including MM/YY timeframes
California State Medical License (wallet-sized copy)
Malpractice Certificate (minimum coverage must be $1,000,000/$3,000,000)
Evidence of Board Certification and/or qualification for examination by the appropriate board
ECFMG Certificate (if foreign graduate)
Current Cyber Certificate (contact us for more information)
If you answered “Yes” to any of the attestation questions, there must be an attached explanation with regards to the reason for answering “Yes,” what the outcome was, and when it was resolved.
Please account for any time gaps greater than six months in practice history after completion of training. (Note: A minimum of 5 years of work history is required to be noted on the application) This information must be noted on the application as well as your curriculum vitae.
As part of the initial credentialing process, the applicant has the right upon request to be informed of the status of your application within your legal rights. The applicant had the right to review the information submitted in support of the application or to correct erroneous information listen on the application by submitting a written request to firstname.lastname@example.org. If we do not receive the application within the specified time frame we will assume that the applicant is no longer interested in participating in our network.