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 toDr. Aisha Grant, MD
CredentialPayer enrollment (MCD)
NumberMCD-ENR-DEMO-4065
Issued byState Medicaid
Valid fromJun 20, 2023
Valid throughJun 20, 2028

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