Physician Revenue Cycle Management – Onboarding Provide Profile Name D.B.A. Specialty Business Address Practice Location Office Phone Office Fax D.E.A. Individual NPI Group NPI PTAN Medical License Tax ID SS # DOB Email Taxonomy Voided Business Check **Please provide a copy of all: Medical Licenses, Degrees, L.O.I., W-9, Driver’s License, voided check and Resume.**. Note: We do request access to your CAQH and other site log-ins as needed. CAQH: ID Password Others: Site Name ID Password Site Name ID Password Site Name ID Password Most Common CPT Codes and Frequency:
