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Join EPMN!

Follow the instructions below to initiate your membership application.

Getting started is simple!

We highly recommend the use of CAQH if you have an active account. CAQH is a FREE tool for physicians and mid-level providers. Please download a copy of your CAQH provider profile and submit it to EPMN with the following documentation.


  • Participating Practice Agreement
  • Business Associate Agreement
  • IRS Form W-9 (make sure the information you provide on this form is identical to the information the IRS provided when they issued your federal employer identification number)
  • Texas Workers' Compensation Required Information Form
  • Supplemental Credentialing Information Form

All done?

Submit your COMPLETE package by EMAIL (Scanned Copies), Fax, U.S. Mail or Overnight Delivery Services to:

EPMN Credentialing Verification
Fax: 469-757-8883
[email protected]
Office: 972-424-1360


INCOMPLETE APPLICATION PACKETS WILL NOT BE PROCESSED. THERE WILL BE NO EXCEPTIONS.

Your Application Packet must contain:

  • A completed Application – all aspects of the Application must be complete or marked “not applicable.” Blanks without explanation will not be accepted and will result in a rejected application.
  • 100% of the Supporting Documentation required to accompany your Application.
  • 100% of your Supporting Documentation must be current. If ANY documentation is expired, your Application will be rejected as incomplete.

Questions?

If you have any questions or need some help with your application process, feel free to contact us at (972) 424-1360


Refund Policy

In the event your Application is not approved for any reason, your Membership Dues will be returned to you. Credentialing Fees are non-refundable.

Ready to get started?

Becoming a member is a breeze. Join in just three easy steps.

Become a member today