New Provider Application
Thank you for choosing Berkeley Associates to help with your contracts and credential needs. We are excited to get started with this process.
We have a thorough online form to start the process of your application, based upon your particular discipline. The following instructions will help keep the process as simple and we are always available to answer questions.
There are ciritical documents required to complete your credential filing. Digital copies can be easily uploaded in the final step of the application form.
Select Your Form
We have a thorough online form to start the process of your application, based upon your particular discipline.
Pre-application Credentialing CheckList
- Copy of Current Driver’s License
- Current Copy of State license
- Current Copy of State Narcotics License
- Current Copy of DEA
- Copy of Certification of Specialty Board
- Copy of Professional Diploma – MD, do, PA, ARNP, LPC, OD, DC
- Copy of Masters Diploma ( Nurse Practitioners)
- Copy of current CV (resume)
- Copy of current Professional Malpractice insurance
- Copy of ECFMG, If applicable