Get Cppa Application

The Cppa Application is essential for healthcare professionals seeking participation in a healthcare organization. This guide will provide clear instructions for filling out the Cppa Application online, ensuring all necessary information is accurately submitted.

Follow the steps to complete your Cppa Application online effectively.

1. Press the ‘Get Form’ button to access the Cppa Application and open it in the editor.
2. Begin by entering your identifying information in the designated fields, including your last name, first name, middle name, and any other names you are known by. Provide your home mailing address, telephone number, email address, birth date, and place of birth.
3. In the practice information section, indicate your practice name, primary office address, and contact details. Include names affiliated with tax ID numbers and provide a federal tax ID number.
4. Complete the education section by documenting your premedical education, medical/professional education, and any postgraduate training or experience. Attach additional sheets if necessary.
5. Fill in the board certification section, listing any certifications obtained and their issuance details.
6. Gather and attach copies of required documents, such as your medical license, DEA certificate, board certification, professional liability policy, curriculum vitae, and, if applicable, ECFMG certification.
7. Ensure all required supporting documents are attached and accurately referenced based on your application questions.
8. Review all entered information for accuracy and completeness. Make corrections as needed before final submission.
9. Once you are satisfied with your application, you may save your changes, print the document, download it, or share it as required.

Complete your application online today to ensure a smooth and efficient submission process.