Below is a list of paperwork that needs to be completed and returned at your earliest convenience. Some items will have a web site address for more detailed information and/or application that needs to be completed on-line and submitted.

1. National Practitioner Data Bank www.npdb.com (click on “Perform Self Query", choose “Individual Self Query” and complete)
   
2. Nevada State Board of Medical Examiners (for more information: www.medboard.nv.gov or call 775-688-2559)
   
3. NBME Certification and Transcripts www.nbme.org (Click on “Certification & Transcripts" then click “Request for Endorsement of NBME Certification Form”)
   
4. Malpractice Insurance Application
   
5. Malpractice History Loss, carrier address phone number and contact
   
6. WYBTRAK Credential data base paperwork (not available on-line)
   
7. Nevada State Board of Pharmacy http://bop.nv.gov/
   
8. Curriculum Vitae
   
9. We will also need originals of the following or clean copies:
   • Medical School Certificate
   • Internship Certificate
   • Fellowship Certificate
   • Residency Certificate
   • Board Certifications
   • References Verification
   • Hospital letters of recommendation
   • DD214 (Military Only)
   
10. Passport size pictures (black & white or color)
    
11. Signature Form to create signature stamp
    
12. Drivers License front and back
    
13. CME Certificates
    
14. CPR Certification
    
15. ACLS Certification
    
16. List of Insurance payers contracted with, effective dates, contacts,address phone number and copy of contracts.

*** It is vital that all paperwork be complete within a month of signing a Contract with Pulmonary Medicine Associates. Credentialing must be complete for all entities before you can see patients on behalf of Pulmonary Medicine Associates. The information requested will allow us to commence the licensing, and insurance application process. As soon as the forms are complete they must be mail back to our office in order to address application fees.