CCPA Recredentialing Process

Here is the CCPA Recredentialing Checklist for you to use.  This checklist was created to give you a detailed list of items needed to submit to CCPA for recredentialing.

CCPA Recredentialing Important Items


Support Documents Needed 

  • Signed CCPA Attestation Form*
  • Signed Page Two (2) of Illinois Application
  • All Current Professional License(s) [i.e., State Medical License(s), etc.]          
  • Current State Controlled Substance License 
  • Current Board Certification Certificate
  • Current Federal Drug Enforcement Administration Certificate
  • Current Certificate of Insurance 
  • Current Curriculum Vitae

   *Please click here to access all CCPA forms listed above. 

To view the CCPA recredentialing criteria in more detail, please review the CCPA Credentialing Policies and Procedures.