Practice location form

  • Release version: Zurich
  • Updated July 31, 2025
  • 1 minute to read

    • Access, update, and validate the practice location details of a healthcare professional in the Practice location form.

    Table 1. Practice Location form
    Field Description
    Professional profile Professional profile of the healthcare professional.
    Practice name (in Directory) Practice name of the healthcare professional.
    Corporation name (in W-9 form) Name of the corporation in (W-9 format) to verify name, address, and tax ID.
    Primary tax ID type Type of tax ID: Primary or Individual.
    Individual tax ID Individual Tax ID number against which taxes are collected from the healthcare professional.
    Group tax ID Group tax ID (Employer Tax ID) against which taxes are collected.
    Credentialing reference Option to add a professional reference.
    Office schedule Working schedules of the health care professional, for example, 24 X 7.
    Accept new patients Option to indicate that the healthcare professional can accept new patients.
    Accept new medicaid patients Option to indicate that the healthcare professional can accept new medicaid patients.
    Accept new medicare patients Option to indicate that the healthcare professional can accept new medicare patients.
    Active Option to indicate that the practice location record is available to use.
    Is current location Option to indicate that this is the current practice location of the health care professional.
    Is billing electronic Option to indicate that electronic billing is generated at the affiliated hospital for the services rendered by healthcare professional.
    Send correspondence here Option to indicate that any correspondence (examples: letters) to the healthcare professional can be sent to the affiliated hospital.
    Status Status of the practice location record:
    • New: When profile intake form is sent to the healthcare professional for filling.
    • Pending validation: When data is filled in by healthcare professional and sent for credentialing and validation to HR agents.
    • Invalid: When HR agents review the data and reject due to insufficient or invalid details.
    • Valid: When HR agents validate and approve the information provided by the healthcare professional.
    Address Address of practice location.
    City City in which practice location is situated.
    State/province State in which practice location is situated.
    Zip/postal code Postal code of area in which the practice location is situated.
    Country Country in which the practice location is situated.