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. Samuel Ortiz, MD
CredentialPayer enrollment (HARB)
NumberHARB-ENR-DEMO-4077
Issued byHarborline Health
Valid fromMay 26, 2025
Valid throughMay 26, 2028

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