PVR

Startup playbook

Independent practice startup checklist

Opening an independent practice typically takes 9–12 months from decision to first patient. This checklist sequences the ~120 tasks that matter, grouped into six phases — legal entity, credentialing, real estate, technology, staffing, and go-live.

By Jordan Alderman, MBA, CMPE · Reviewed by Rania Hassan, JD, CHC · Last reviewed · Methodology

Disclosure: Independent editorial. No pay-for-placement, no affiliate rankings. Full editorial standards.

Who this is for: Physicians and clinicians opening a first independent practice, and administrators supporting a new group's launch.

Phase 1 — Entity & legal (months 12–10)

  • Form PC / PLLC / PA per state rules (state-specific — get a healthcare attorney)
  • Obtain EIN from IRS
  • Open business bank account + credit line
  • Register for state tax IDs
  • Purchase malpractice insurance (occurrence preferred)
  • Purchase general liability + workers' comp
  • Draft operating agreement (multi-owner)

Phase 2 — Credentialing kickoff (months 10–7)

  • NPI (individual + group) via NPPES
  • Medicare enrollment (PECOS) — 60–90 days
  • State Medicaid enrollment — 90–180 days depending on state
  • Commercial payer applications (8–15 payers typical) — 90–150 days
  • CAQH profile — 100% complete + re-attested
  • Hospital privileges applications if needed

Phase 3 — Real estate & build-out (months 9–4)

  • Location selection (drive-time analysis vs target patients)
  • Lease negotiation — 5-year with option, TI allowance $40–$100/sf
  • Architect + healthcare-experienced GC
  • Permitting timeline confirmed with local authority
  • Medical equipment leased or purchased
  • Signage + wayfinding

Phase 4 — Technology stack (months 6–3)

  • EHR + PM selection (see /ehr/how-to-choose)
  • Billing / RCM decision: in-house vs outsourced (see /billing-rcm/how-to-choose)
  • Clearinghouse account
  • Merchant services for patient payments
  • Phone system (VoIP with clinical hold + queue)
  • Fax (still needed — DirectTrust or eFax with BAA)
  • Patient portal + telehealth
  • IT: network, workstations, endpoint security
  • HIPAA-compliant email + productivity suite

Phase 5 — Staffing (months 4–1)

  • Practice manager or office manager hired first
  • Front desk / patient access
  • Medical assistant(s) or nurse
  • Billing coordinator (in-house) or billing service kickoff
  • Employee handbook + policies
  • Payroll provider (with healthcare experience)
  • Benefits: health, dental, retirement
  • OSHA + HIPAA training scheduled

Phase 6 — Marketing & go-live (months 3–0)

  • Website + Google Business Profile
  • Local SEO + medical directories
  • Referral network activation
  • Insurance card verification workflow
  • Soft-open week with 25%–50% schedule
  • Full open with all payers active
  • Week-1 daily huddle + issue tracker
  • 30/60/90-day KPI review vs plan