When opening your own medical practice, making sure that you have all the necessary licenses and credentials in place should be at the top of your to-do list. Since the processes can take several months to complete, it’s best to start as soon as you can to ensure that you have everything in place when it’s time for your practice to open its doors to patients.
While many of the following licenses will be familiar to you from your medical training — and you most likely have some of them already — the following list can help you make sure that you don’t overlook any part of the process. This checklist can also serve as a resource for your practice manager to guide license renewal processes in the future.
The list below is not exhaustive, and requirements for both licenses and permits can vary significantly based on your location and the nature of your speciality. Consult with local healthcare authorities, licensing boards, or legal consultants who specialize in healthcare to ensure compliance with all the necessary licenses and regulations.
Your medical license is a fundamental requirement for practicing medicine legally. According to the American Medical Association (AMA), current licensure procedures require providers to complete individual medical license applications for each state in which they want to practice, including telemedicine, unless the state is a member of the Interstate Medical Licensure Compact or the state has a waiver in place for telemedicine. The Compact, which currently includes 37 states, is an agreement among participating states and territories that streamlines the licensing process for physicians who want to practice in multiple states.
When you apply for your license for the first time or seek a license from a new state, it’s a good idea to research the exact licensing requirements, including application fees and renewal intervals. The Federation of State Medical Boards (FSMB) provides a comprehensive list of contact information for each state medical board, as well as resources to make the process easier. It’s important to find out if the state in which you are applying has separate boards for medicine and osteopathy and if the state is a member of the Interstate Medical Licensure Compact.
How long does it take to get a medical license?
Each state has a different process for reviewing applications and the timeframe for approval varies. Typically, it takes at least 60 days or 2 months from the time you submit your application for licensure to be granted, though it can take longer if your application is incomplete or inaccurate. If you graduated from a medical school outside the United States, the process may take even longer.
What do I need to submit with my medical license application?
The FSMB has created the Uniform Application for Licensure (UA) program to help streamline the application process, but state participation varies. The program is intended to eliminate the need for physicians and resident applicants to re-enter information when applying for licenses in multiple states.
If your state participates in the UA program, fill out the application. If your state does not participate, find your state’s specific application for licensure and submit it, along with supporting documents. These documents may include a birth certificate, curriculum vitae (CV), medical school transcripts, licensing examination scores, letters of recommendation, application feed, malpractice information, criminal background check, proof of citizenship or non-citizen status in the United States, and other documents to verify your identity and qualifications.
It’s important to submit everything required and to disclose any derogatory information, such as disciplinary history or malpractice claims, at the time of your application. If you have issues in your record that are cause for concern, the best approach is to help the board obtain the records and other necessary data it needs, and to provide any mitigating circumstances or justifications that may prevent the denial of a license. Making a false statement on an application for licensure is grounds for denial or future restriction in most jurisdictions.
After you apply
Once the licensing board receives your application and supporting documents, it will begin to review and verify your credentials, including your medical education, training, and examination results. It may also evaluate any disciplinary history or malpractice claims against you, as well as query the National Practitioner Data Bank (NPDB) for any complaints against you. Even uncomplicated applications can take a long time to verify.
When the licensing board has finished its review and verified your credentials, it will make a decision regarding your medical license. It may grant you a full license, impose conditions or restrictions on your license, or deny your application.
Most states require that doctors renew their licenses every 2 years, and the renewal process will likely involve paying a renewal fee and fulfilling continuing education requirements. If you have licenses in more than one state, it can be helpful to get them on the same renewal cycle.
National Provider Identifier (NPI) number
The National Provider Identifier (NPI) was created as part of the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. This 10-digit, intelligence-free, and unique identification number is assigned to all covered healthcare providers and must be used by health plans and health care clearinghouses in administrative and financial transactions. NPI numbers do not expire or need renewal. Most physicians in the US apply for an NPI during their residency or internship and your number will stay with you for life.
To apply for an NPI, visit the NPI Enumerator website, which is operated by the Centers for Medicare & Medicaid Services (CMS).
The NPI Enumerator site offers an online application or a paper application.
- The online application process is typically faster and more convenient. You will need to create an account on the NPI Enumerator’s website and provide the required information online.
- To submit a paper application, download the NPI Application/Update Form (Form CMS-10114) from the NPI Enumerator’s website. After completing the form with the necessary information, print it and mail it to the address specified on the form.
Both application methods require you to gather specific information before starting the application process. This includes personal details, such as your social security number or employer identification number, contact information, professional qualifications and license information, and practice details.
Once your application is submitted, the NPI Enumerator will process your application. This may take a few weeks. You can track the status of your application using the information provided during the application process. Once your application is approved, you will receive an NPI notification. This notification will contain your unique NPI number and instructions on how to access and manage your NPI record.
If you plan to prescribe or administer controlled substances at your new medical practice, and have not completed the process already, be sure to register with the Drug Enforcement Administration (DEA). You can submit an application for DEA registration and pay for your application online. You must have your medical license before you submit your DEA registration, so plan accordingly. Your DEA number will stay with you throughout your entire career in medicine, though you will need to renew it every 3 years.
Controlled substance registration
Some jurisdictions have additional requirements for handling and storing controlled substances within a medical practice, so check with your local medical board to confirm your state’s regulations.
Medical credentialing is one of the most important processes that a provider must undergo — and repeat anytime they change their place of employment or apply for privileges at a new facility.
Obtaining your medical license and your medical credentialing are separate processes. Medical credentialing allows you to contract with and be reimbursed by payers, such as health insurance companies. Unless you plan to use a direct primary care model, the credentialing process is critical to processing insurance claims and can take over 4 months to complete, so start the process as soon as you can.
Not all insurance companies or plans operate in every location, so it’s wise to determine which insurance programs your patients will likely expect you to accept. In addition to major national carriers such as Aetna, Blue Cross/Blue Shield, Cigna, Humana, and United Healthcare, check into any regional insurance carriers and specialized, state-based Medicaid programs.
Once the insurance company approves you for credentialing, you will enter the contract phase. During this process, you contract with the insurance company outlining which in-network services you will provide, the percentage of your fee they will reimburse, and how you will receive reimbursement from them.
Medical credentials for insurance will need to be renewed regularly, though the frequency depends on the specific company and the timeframe can vary from 12 months to 3 years. Once your practice is up and running, you can hand the renewal process over to your office manager or to credentialing coordinator.
What to know if you move practices
Anytime your practice is affiliated with a different employer tax ID number (EIN), you will need to obtain new credentials. Your insurance credentials do not move with you from one medical practice to another. Any additional providers you hire may also need to undergo the credentialing process when they join the practice, so keep this in mind when considering timelines for onboarding.
Billing Centers for Medicare & Medicaid Services
If you intend to bill the Centers for Medicare & Medicaid Services (CMS), you will need to complete the enrollment process for providers. This process requires you to have an NPI, to fill out the online PECOS enrollment form, and to work with a Medicare Administrative Contractor (MAC) in the region where you practice. The MAC assigned to you may request additional information while they process your application. Your MAC also serves as the point of contact for any questions regarding your enrollment status.
The burden will be on you to keep your CMS enrollment up to date. To avoid having your Medicare billing privileges revoked, you must report any change in ownership or practice location, or any adverse legal action to CMS within 30 days.
Depending on your specialty and location, you may want to pursue hospital privileges with a local facility. There are 3 types of hospital privileges:
- Admitting privileges authorize physicians to admit patients into a specific hospital or medical center.
- Courtesy privileges authorize physicians to occasionally treat or admit patients into a specific hospital or medical center.
- Surgical privileges authorize a surgeon to perform surgical procedures at a specific hospital or medical center.
To obtain hospital privileges, a physician typically completes an application form provided by the hospital’s medical staff office. The application requires detailed information about your education, training, experience, board certifications, and professional references.
The hospital’s medical staff office will then review your credentials, including verification of education, training, licensure, board certifications, and malpractice history. They may also check your references and evaluate your clinical competency. Depending on the bylaws of its Medical Board, the hospital may or may not grant privileges.
If you do receive privileges, however, it’s likely that you will have to undergo the credentialing process for the hospital.
Insurance and liability coverage
While you wait for approval on your medical license and credentialing, begin to research options for malpractice insurance. When assessing different policies, consider the types of claims the policy covers as well as any limits to the coverage. Adequate coverage should align with the specialty and scope of your practice to ensure comprehensive protection. Make sure that the cost of premiums and any deductibles associated with the policy fit within your budget while providing adequate coverage. Additionally, review the policy’s terms and conditions, including any exclusions or limitations, to fully understand the coverage and potential gaps.
It’s important to evaluate the reputation and financial stability of the insurance provider to ensure they have a strong track record of handling claims effectively. An experienced insurance agent or broker who specializes in medical malpractice insurance can help you select a policy tailored to your practice’s needs and risk profile.