← Readiness queue
PRV-4004
In reviewSynthetic provider file · no real PII / no PHIEmergency physician · Emergency medicine · TRH Main — ED
Weighted readiness
88
4/6 checks verified
Deadline
44d
Recredential due 2026-08-25
Flags
2 attentionexclusion clear
Primary-source verification checklist
| Dimension | Status | Detail | Primary source | Weight |
|---|---|---|---|---|
| State medical license | Verified | Active | TMB primary source (batch PSV) | 25% |
| DEA registration | Verified | Active | DEA CSA registry (batch) | 15% |
| Board certification | Pending | Re-cert exam result pending | ABMS (batch) | 15% |
| Payer enrollment (UHC) | Verified | Active, PAR | UHC enrollment export | 20% |
| OIG-LEIE / SAM exclusion | Verified | No match on last batch screen | OIG-LEIE + SAM.gov (batch) | 15% |
| Malpractice coverage | Expiring | COI expires 2026-08-01 — renewal pending | COI on file | 10% |
Evidence provenance
- Owner
- R. Okafor
- Evidence
- Credentialing packet PRV-4004 · PSV batch 06-30
- Linked agreement
- Commercial Payer Participation Agreement
Readiness workflow
Demo action — resets on reload · not persistedChronology & session activity
- seed2026-06-22 — PRV-4004 surfaced by VERIFY readiness rule from the Credentialing + PSV batch extract · FY2026 Q3.
- seed2026-06-22 — Primary-source verification results reconciled against agreement scope and payer enrollment.