Get Caqh Forms

Completing the CAQH Provider Data Form is an essential step in the credentialing process for providers in the Rochester and Buffalo regions. This guide will provide clear instructions on how to accurately fill out the form online to ensure a smooth credentialing experience.

Follow the steps to complete the Caqh Forms accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Enter the date at the top of the form.
3. Fill in your last name, first name, and middle initial as required.
4. Provide your date of birth.
5. Input your primary telephone number.
6. Enter your primary office street address, city, suite number, state, county, and zip code.
7. Complete the Practice Tax ID section and remember to include the W-9.
8. List your practice name and start date.
9. Select your provider type (e.g., MD, DO, DDS, DMD, DPM, Independent NP/CDE).
10. Indicate whether you are applying as a primary care provider or a specialist, and specify your specialty.
11. If applicable, indicate if you are board certified and provide the board name.
12. Indicate if you are registered with CAQH and provide your CAQH Provider ID if yes.
13. Enter your primary fax number and email address.
14. Provide your Social Security number and DEA certificate number.
15. Input your state license number and licensed state.
16. Provide your NPI number.
17. Once all sections are completed, save your changes, then download, print, or share the completed form as needed.

Complete your Caqh Forms online today to expedite your credentialing process.