(959) 240-0580
Info@speedycredentialing.com

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Our Services
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Contact Us
Terms & Policies

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Home
About Us
Our Services
FAQ’s
Contact Us
Terms & Policies

Home
About Us
Our Services
FAQ’s
Contact Us
Terms & Policies

Enrollment

Credentialing Checklist

Provider/Facility Details

Name

SSN No or (Last 4 Digit of Your SSN)

DOB

Percentage of Ownership

NPPES username

NPPES password

Speciality

Email Address

Cell No.

Facility/Agency Name

Tax ID

NPI Type 1 (individual)

NPI Type 2 (group)

Primary Service Address

Pay to Address

Mailing Address

Office Hours at location

Appointment Phone No.

Fax No.

Office Email

Office Manager/Contact

CAQH logins

Documents

State License

IRS Letter

Accreditation Letter

Malpractice/ PLI / COI

W9 Form

Voided Check/ Bank Letter

Owner Driving License

Resume / CV

Insurance Company

ACI Specialty Benefits Aetna Amerigroup AmeriHealth Anthem Banner Health Beacon Health Options Blue Cross Blue Shield CareConnect Health Plan Centene Corporation CHAMPVA Choice Health-Care Network Cigna and Ever-north ComPsych EmblemHealth GHI Great-West Life Health Net Health Net I MHN Health Plus Horizon Blue Cross Horizon Blue Cross and Blue Horizon Healthcare Humana Kaiser Permanente Magellan MagnaCare Medicaid Medicare Mercy Care Meridian Molina Healthcare MultiPlan Optum Oscar Health Oxford Phoenix Health Plan Sharp Health plan TRICARE UMR UnitedHealthcare UHC I UBH VA Community Care Network Other

Write Other Insurance Company that you want to be registered that are not mentioned in our list

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Reach Us

6438 Ashby Grove Loop Haymarket, VA 20169
(571) 281-8988
Info@speedycredentialing.com