Follow the instructions below to initiate your membership application.
We highly recommend the use of CAQH if you have an active account. CAQH is a FREE tool for physicians and utilizing CAQH significantly speeds your application processing time!
If you do not have an active CAQH account, download the participation application and complete, sign, date and return the following:
Submit your COMPLETE package by EMAIL (Scanned Copies), Fax, U.S. Mail or Overnight Delivery Services to:
INCOMPLETE APPLICATION PACKETS WILL NOT BE PROCESSED. THERE WILL BE NO EXCEPTIONS.
Your Application Packet must contain:
If you have any questions or need some help with your application process, feel free to contact us at (972) 424-1360
In the event your Application is not approved for any reason, your Membership Dues will be returned to you. Credentialing Fees are non-refundable.