Required Documents

To complete the credentialing process, providers will need to send Health Wise Credentialing Solutions the following documents:

  • Practitioner License(s)
  • Malpractice Insurance (Certificate of Insurance)
  • DEA (federal) and state CSR certificates (if applicable)
  • Board Certification(s)
  • Diploma – copy of highest level of education (Master’s degree, PA, DPT, etc.)
  • 5 years of work history, if not uploaded in CAQH
  • IRS Form W-9* Taxpayer Identification Verification Form (
  • IRS form CP575 or replacement letter 147C (verification of EIN)
  • Copy of office lease (required for independent therapy facilities to enroll with Medicare)
  • Bank account verification – a voided check with the business name, which must be exactly as shown on the IRS CP575 or a letter from your bank on letterhead verifying your bank account. The business name must be exactly as it is on file with the IRS, which includes: punctuation, abbreviations, etc.