Download is available until [expire_date]
  • Version
  • Download 24
  • File Size 4.00 KB
  • File Count 1
  • Create Date March 20, 2023
  • Last Updated March 20, 2023

CPPA Application

Allied Health Solutions, IPA accepts the California Participating Physician Application (CPPA).
To become credentials for the first time, you will need a current and complete application.

Please be sure to:

  • Complete all fields on the form or mark them “N/A”
  • Include all prior and current practice locations.
  • Include identification numbers, such as the physician or provider’s Social Security Number, National Provider Identifier (NPI), Drug Enforcement Agency Number, unique provider ID, and professional license numbers.
  • Answer all questions and provide explanations if needed.
  • Include the signed and dated attestation form.

Provide digital copies of your:

  • Curriculum vitae, including work history in a month/year format
  • Professional license or DEA certificate
  • Controlled Dangerous Substances (CDS) certificate
  • Copy of malpractice insurance face sheet
  • Summary of pending or settled malpractice cases