SAMPLE for the demonstration: a fictional certificate, not a real document. In real use this is the scan or PDF the coordinator attaches.

Payer enrollment

Ridgeline Health Partners credential file

Issued toTheo Ramirez, PA-C
CredentialPayer enrollment (LARK)
NumberLARK-ENR-DEMO-4053
Issued byLarkspur Health Plan
Valid fromJan 6, 2025
Valid throughJan 6, 2028

Fictional provider and number. Close this tab to return to the Credential Tracker.