Profile Information:

The Practitioner Profile displays the following information:

• NPI: The National Provider Identifier. (e.g., "1720089126")

• CAQH ID: The Council for Affordable Quality Healthcare ID. (e.g., "10422045")

• First Name: The practitioner's first name. (e.g., "Rodrigo")

• Middle Name: The practitioner's middle name (if applicable).

• Last Name: The practitioner's last name. (e.g., "Erlich")

• Practitioner Type: The practitioner's professional designation. (e.g., "MD")

• SSN: Social Security Number (Click to Add).

• Date of Birth: (Click to Edit). (e.g., "3/05/1964")

• Sex: (Select an option).

• Gender Identity: (Select an option).

• Ethnicity: (Select an option).

• Race: (Select an option).

• Birth Place, Country: (Select an option).

• Birth Place, City: (Type here).

• Languages: (Click to Add/Edit). (e.g., "[NONE]")

Profile Sections:

• Contact Details:

  • Addresses: Displays a list of addresses.

  • Phone Numbers: (Not populated in the screenshot)

  • Email Addresses: (Not populated in the screenshot)

  • Add Contact Details Button: Allows adding new contact information.

• Licenses:

  • Displays a table of licenses with State, License Type, License Number, Status, Issue Date, and Expiration Date.

  • Add License Button: Allows adding new license information.

• CME (Continuing Medical Education):

  • Display CME Title,Hours, Description, Completion Date, Category 1

  • Add CME Button: Allows adding new CME information.

• References:

  • Displays Add Reference Name, Title Years Known, Institutions/Employer, Address, City State, Zip Fax no., Email Phone

  • Add References Button: Allows adding new reference information.

• Liability Insurance:

  • Displays a list of liability insurance entries with Insurance Company Name, Policy Number, and Effective Date.

  • Add Insurance Button: Allows adding new liability insurance information.

• DEA & CDS Registrations:

  • Allows input of DEA and CDS registration information with State, Number, and Expiration Date.

  • Add DEA & CDS Registration Button: Allows adding new registration information.

• Medicare and Medicaid:

  • Allows input of Medicare and Medicaid information with State and Number.

  • Add Medicare & Medicaid Button: Allows adding new Medicare or Medicaid information.

• Employment:

  • Displays Education Type, Degree Type, Major/Speciality, Institute Name, Institute Address, City State, Country Zip, Start Date End Date Award Date

  • Add Employment Button: Allows adding new employment history information.

• Admitting Privileges & Arrangements:

  • Displays Admission Type, Status, Contact Name, Hospital Name, Department Name, State Country, Start Date Admission Percentage

  • Add Admitting Privileges Button: Allows adding new admitting privileges information.

Education section:

• Displays a list of education entries with Start/End Dates, Institution Name, and Additional Details.

• Add Education Button: Allows adding new education entries.

Postgraduate Training section: 

• Displays a list of postgrad training entries

• Add Postgraduate Training Button: Allows adding new postgraduate training entries.

Exams section:

•  Displays a list of exam entries

• Add Exams Button: Allows adding new exam entries.

Documents section:

• Displays a list of uploaded documents with Document Title and Upload Date.

• Add Document Button: Allows uploading new documents.

Login Credentials:

• Displays a list of login credentials with Credential Name and Credential Value/Description.

• Add Login Credentials Button: Allows adding new login credentials.