Get Nm Credentials Application

This guide provides a clear and supportive roadmap for users on how to successfully complete the NM Credentials Application online. Whether you are familiar with online forms or new to the process, these detailed instructions will help you navigate each section with confidence.

Follow the steps to fill out the NM Credentials Application online

1. Press the ‘Get Form’ button to retrieve the NM Credentials Application and open it in your document editor.
2. Complete the top section with the name(s) of the health care organization(s) you are applying to and the date of application.
3. Fill in your full name, including last name, first name, middle name, and any other names previously used.
4. Indicate your current licensures by circling all applicable categories (e.g., MD, DO) and list your specialty.
5. Provide information on your gender, place of birth, citizenship, social security number, and date of birth.
6. Enter your state tax ID and federal tax ID if applicable. Include your Medicare and Medicaid numbers as well.
7. List the unique physician identification number (UPIN) and the office manager’s contact details.
8. Specify your practice/group name, effective date, and complete the office address and contact numbers.
9. Indicate whether you speak any foreign languages fluently and fill out your current mailing address if it differs from the office address.
10. Respond to the questions regarding credentialing as a primary care provider and whether you deliver babies.
11. Include any additional practice locations and their details as necessary.
12. Complete the professional references section by listing at least five individuals familiar with your professional performance.
13. Provide your education details by listing undergraduate and graduate education, including schools attended and degrees earned.
14. Detail your post-graduate training, including hospitals and programs attended, specifying type and dates.
15. Outline your work history for the past fifteen years, including organization names, positions, dates, and reasons for any employment gaps.
16. Complete the hospital and healthcare affiliations section with relevant details regarding your current and past affiliations.
17. Provide information related to your military service, licenses, and professional liability insurance details as applicable.
18. Address the specialty board certifications and professional practice questions, ensuring all are answered clearly.
19. Sign and date the applicant’s attestation statement and be mindful that signature stamps are not accepted.
20. Review the checklist of documents required to be submitted with your application and ensure all are attached.

Complete your NM Credentials Application online to ensure a smooth credentialing process.