Credentials

Every credential on file and every requirement with nothing on file, in the order work has to happen.

As of

Oct 7, 2026

Pick as many as you like in each row. A record shows if it matches any pick in a row, and every row.

All statuses Needs action Lapsed Missing Expiring Pending Action due Current Not verified at source

All types State medical license DEA registration State controlled substance registration Board certification Malpractice insurance CAQH attestation Payer enrollment Hospital or surgery center privileges CPR / BLS certification OIG exclusion check

All sites East Region West Region Eastgate Family Care Jefferson Park Main Campus Riverbend Riverside Orthopedics Stonebridge

67 records, showing 51 to 67. Clear all filters

Dr. Ethan Cole
State medical license (TN)
Current
Current. Start the renewal by Jul 28, 2028.No. TN-LIC-DEMO-4134Ends Oct 28, 2028
Dr. Owen Hale
Payer enrollment: Harborline Health
Current
Current. Start the renewal by Jul 27, 2028.No. HARB-ENR-DEMO-4010Ends Nov 24, 2028
Dr. Aisha Grant
Payer enrollment: Larkspur Health Plan
Current
Current. Start the renewal by Jul 27, 2028.No. LARK-ENR-DEMO-4066Ends Nov 24, 2028
Dr. Julian Moore
Payer enrollment: Larkspur Health Plan
Current
Current. Start the renewal by Aug 17, 2028.No. LARK-ENR-DEMO-4118Ends Dec 15, 2028
Dr. Hannah Weiss
Payer enrollment: Harborline Health
Current
Current. Start the renewal by Sep 1, 2028.No. HARB-ENR-DEMO-4089Ends Jan 1, 2029
Dr. Ethan Cole
Payer enrollment: Harborline Health
Current
Current. Start the renewal by Sep 22, 2028.No. HARB-ENR-DEMO-4144Ends Jan 22, 2029
Grace Liu
Payer enrollment: Bluestem Mutual
Current
Current. Start the renewal by Oct 24, 2028.No. BLUE-ENR-DEMO-4133Ends Feb 21, 2029
Dr. Samuel Ortiz
Payer enrollment: Medicare
Current
Current. Start the renewal by Oct 24, 2028.No. MCR-ENR-DEMO-4075Ends Feb 21, 2029
Dr. Marcus Bell
Payer enrollment: Larkspur Health Plan
Current
Current. Start the renewal by Oct 26, 2028.No. LARK-ENR-DEMO-4031Ends Feb 23, 2029
Theo Ramirez
Payer enrollment: Harborline Health
Current
Current. Start the renewal by Dec 1, 2028.No. HARB-ENR-DEMO-4054Ends Apr 2, 2029
Dr. Samuel Ortiz
Payer enrollment: Bluestem Mutual
Current
Current. Start the renewal by Jan 12, 2029.No. BLUE-ENR-DEMO-4078Ends May 14, 2029
Caleb Foster
Payer enrollment: Medicare
Current
Current. Start the renewal by May 18, 2029.No. MCR-ENR-DEMO-4098Ends Sep 17, 2029
Dr. Priyanka Rao
Payer enrollment: Medicare
Current
Current. Start the renewal by Apr 30, 2030.No. MCR-ENR-DEMO-4108Ends Aug 28, 2030
Grace Liu
Payer enrollment: State Medicaid
Current
Current. Start the renewal by Nov 8, 2030.No. MCD-ENR-DEMO-4132Ends Mar 10, 2031
Grace Liu
Payer enrollment: Medicare
Current
Current. Start the renewal by Nov 22, 2030.No. MCR-ENR-DEMO-4131Ends Mar 24, 2031
Dr. Julian Moore
Payer enrollment: Medicare
Current
Current. Start the renewal by Dec 18, 2030.No. MCR-ENR-DEMO-4117Ends Apr 17, 2031
Dr. Hannah Weiss
Payer enrollment: State Medicaid
Current
Current. Start the renewal by Apr 18, 2031.No. MCD-ENR-DEMO-4087Ends Aug 18, 2031