The Complete Checklist for Opening a New Medical Practice
A complete checklist for opening a medical practice covers five buckets: Legal (entity, EIN, NPI, licenses, DEA), Financial (malpractice, banking, payments, bookkeeping), Operational (EHR, scheduling, intake, space or telehealth), Compliance (HIPAA safeguards, BAAs, privacy notice, consents), and Growth (brand, website with booking, first-patient plan). A cash-pay practice can complete every item in weeks because it skips the 90–150-day payer credentialing wait; an insurance-based practice should plan 6–12 months. Work the phases below in order; items within a phase run in parallel.
Complete checklist for opening a medical practice: legal, financial, operational, compliance, and growth items with owners and timing. Cash-pay: weeks.
This is the companion checklist to the full narrative sequence: for the why behind each item and the dependencies between them, read How to Start Your Own Medical Practice From Scratch: The Complete Sequence.
Phase 0: Before you build anything
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | Choose payment model: cash-pay (DPC/concierge/functional) vs. insurance | You | Decide first | Determines every downstream item, including whether Phase 6 exists |
| ☐ | Set target panel size and pricing | You | With model decision | DPC panels commonly cited at 400–800 patients; price to market and cost structure |
| ☐ | Review employment contract: non-compete + moonlighting clauses | Healthcare attorney (your state) | Before any patient-facing step | Physician Non-Compete Clauses, Explained: What They Mean and Whether Yours Is Enforceable: foundation-building is generally fine; seeing patients may not be |
| ☐ | Confirm personal runway: 6–12 months of expenses | You | Before committing | Launch speed ≠ panel ramp; most model 6–18 months to a sustaining panel |
| ☐ | Decide telehealth / hybrid / physical space | You | With model decision | Physical build-out adds months and major cost |
Legal** (entity, EIN, NPI, licenses, DEA),
From the article
Phase 1: Legal
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | Form PC/PLLC per your state's rules | Attorney or formation service | Days–weeks, varies by state | Check CPOM ownership restrictions first How to Set Up the Legal Entity for Your Medical Practice (PC, PLLC, and the CPOM Problem) |
| ☐ | Obtain EIN | You or delegable | Days | Needed for banking and Type 2 NPI |
| ☐ | Confirm individual NPI; obtain organizational (Type 2) NPI via NPPES | You or delegable | Days | Both are needed |
| ☐ | Verify active, unrestricted state medical license in every practice state | You | Weeks–months if new states needed | Includes each patient's state for telehealth Licenses and Credentialing You Need to Open a Clinic |
| ☐ | DEA registration (if prescribing controlled substances) | You or delegable | Some states require a separate controlled-substance registration | |
| ☐ | State/local business licenses and permits | Delegable | Varies by locality | Often forgotten until a deadline |
Phase 2: Financial
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | Bind malpractice insurance | Broker | Days–weeks | Claims-made vs. occurrence; resolve old-job tail coverage (can run five figures) |
| ☐ | Open business checking | You | Days | Never commingle personal and practice funds |
| ☐ | Set up payment processor / membership billing | Delegable | Days–1 week | Cash-pay needs recurring membership billing, not a claims module |
| ☐ | Stand up bookkeeping | Delegable | Days | Clean books from day one |
| ☐ | Build startup budget + payback model | You | Before spending | Line items: How Much It Costs to Start a Private Medical Practice (Real Numbers) |
Phase 3: Operational
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | EHR / charting system, configured to your model | Delegable | 1–3 weeks integrated; longer assembling a stack | One of the two items that most often stalls physicians |
| ☐ | Online scheduling | Delegable | With EHR | Ideally native to the same system What Software You Need to Run an Independent Medical Practice |
| ☐ | Patient intake and forms | Delegable | With EHR | Digital, signed before first visit |
| ☐ | Secure (HIPAA-compliant) patient messaging | Delegable | With EHR | Core to membership models |
| ☐ | Lab and pharmacy arrangements/integrations | You + delegable | 1–2 weeks | In-house labs trigger CLIA: see Licenses and Credentialing You Need to Open a Clinic |
| ☐ | Space lease or telehealth platform | You | Telehealth: days. Lease + build-out: months | The single biggest optional timeline/cost item |
| ☐ | Basic clinical supplies | Delegable | 1–2 weeks | Scope-dependent |
Phase 4: Compliance
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | HIPAA security risk analysis | You or compliant platform | 1–2 weeks on a compliant platform; months DIY | Required: and the other most common stall point |
| ☐ | Technical safeguards: encryption, role-based access, MFA, audit logs | Platform/vendor | With systems setup | Built-in if the platform is already HIPAA-compliant |
| ☐ | BAA executed with every vendor touching PHI | You | Before any PHI flows | The rule: no BAA, no PHI HIPAA Compliance for a New Clinic: What You Actually Need on Day One |
| ☐ | Notice of Privacy Practices published | Delegable | Days | Patient-facing requirement |
| ☐ | Patient consent + financial-responsibility forms | Delegable | Days | Membership agreement too, for cash-pay |
| ☐ | Workforce HIPAA training scheduled (annual) and documented | You | Before launch; recurring | Applies even to tiny teams |
Phase 5: Growth
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | Practice name and brand | You + delegable | 1–2 weeks | Confirm name availability with entity filing |
| ☐ | Website with online booking/enrollment | Delegable | 1–3 weeks | Simple and high-trust beats elaborate |
| ☐ | Google Business Profile | Delegable | Days | Free local visibility |
| ☐ | First-patient enrollment plan | You | Before doors open | Network, community, story: not paid ads How to Get Your First Patients for a New Practice |
| ☐ | Retention / recall workflow | Delegable | With EHR | Memberships compound when patients stay |
Phase 6: Insurance practices only
Skip this entire phase if you're cash-pay: that's why cash-pay opens in weeks.
| ✓ | Item | Owner | Typical timing | Notes |
|---|---|---|---|---|
| ☐ | CAQH ProView profile complete and attested | You or delegable | 1–2 weeks | The data hub most payers pull from |
| ☐ | Payer enrollment applications submitted | Delegable | Submit as early as possible | Start the clock immediately |
| ☐ | Commercial credentialing cleared | Payers | 90–150 days (verified industry range) | You cannot bill until it clears |
| ☐ | Medicare / Medicaid enrollment (if participating) | Delegable | Medicare ~15–90 days; Medicaid ~60–120 days | Varies by state and program |
| ☐ | Billing/RCM workflow and coding support | Delegable | Before go-live | A whole overhead category cash-pay avoids |
Launch-week verification
| ✓ | Item |
|---|---|
| ☐ | Test booking → intake → visit → payment end to end as a fake patient |
| ☐ | Confirm every PHI vendor has a signed BAA on file |
| ☐ | Verify malpractice certificate dates cover your first visit |
| ☐ | Confirm prescribing workflow (and DEA number where applicable) works from your EHR |
| ☐ | Charge and refund a real test payment through the membership/payment system |
| ☐ | Publish hours, pricing, and booking link; announce to your network |
How to use this checklist
Work Phase 0 to completion first: every later item depends on the model decision and contract check. Phases 1 and 2 run in parallel. Phases 3 and 4 run in parallel with each other once vendors are chosen. Phase 5 starts as soon as the name and pricing exist. Phase 6, if it applies to you, starts as early as humanly possible, because nothing you do shortens the payer-side wait.
What people get wrong with this list: physicians overwhelmingly stall on two items: EHR setup and HIPAA/consents: and on the meta-problem of doing all ~40 items alone, sequentially, in the evenings around a full-time job. Notice the "Owner" column: the large majority of items are delegable. None of them requires your medical judgment. The list is finite; treat the delegable items as delegable and the checklist stops being the reason you don't launch.
Reality check
A completed checklist gets you a clinic that is open, not a clinic that is full. Budget 6–12 months of personal runway, expect a 6–18 month ramp to a sustaining panel, and treat patient demand in your market as the one item no checklist can verify in advance: only a small live panel can. Items marked above carry timing estimates that vary by state or vendor; verify them for your state before you build your calendar around them, and use a healthcare attorney licensed in your state for the contract and entity items. Timeline detail: How Long It Actually Takes to Open a Private Medical Practice. Costs: How Much It Costs to Start a Private Medical Practice (Real Numbers).
Frequently asked
How many items are on a medical practice startup checklist?+
Roughly 40 discrete items across five buckets: legal, financial, operational, compliance, and growth: plus a sixth bucket (CAQH and payer credentialing) only if you bill insurance. Most are administratively simple; the difficulty is volume and unfamiliarity, not any single item.
What's the most commonly missed item when opening a practice?+
BAAs are the classic one: practices go live with a vendor that touches PHI but never signed a Business Associate Agreement. Close behind are the old employer's tail coverage and local business permits. The launch-week verification table above exists to catch these.
What order should I complete the checklist in?+
Phase 0 (model, contract, runway) first, then Phases 1–2 in parallel, then 3–4 in parallel, with 5 overlapping. If you bill insurance, submit Phase 6 applications the moment your NPIs exist: credentialing is the long pole and nothing else can shorten it.
Can someone else do most of this for me?+
Yes. Almost everything except the model decision, pricing, and clinical scope is delegable to a launch service, attorney, or platform: which is exactly how cash-pay practices compress the checklist into weeks. The alternative is acting as your own general contractor across a lawyer, an EHR vendor, a biller, and a web developer.
Is the checklist different for a telehealth-only practice?+
The structure is identical; you drop the lease/build-out and supplies items and add licensure in every state where your patients are located. Telehealth is the leanest version of the checklist and the fastest to complete.
General information, not legal advice. State requirements vary: verify licensing, entity, and permit items with your state boards and a healthcare attorney licensed in your state.
