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Physician Assistant Application Information

Physician Assistants are required to submit their individual and/or group applications via PAVE (Provider Application and Validation for Enrollment)​.  

Licensing

Prior to applying to Medi-Cal, first check California Board of Registered Nursing Web site to ensure you meet all the licensing requirements.

Required Documents

Next, gather the required documents listed below, as applicable, in order to upload them into PAVE as you complete your PAVE application. Please ensure the uploaded documents are legible.
  1. California Physician Assistant License, California Medical License of the applicant’s supervising physician and California Medical License of the applicant’s employing provider, if applicable and if different than the supervising physician.
  2. Driver’s License or state-issued identification cards (issued within the 50 United States or the District of Columbia) for each of the following:
    • The Licensed Physician Assistant Applicant
    • The Supervising Physician named on the application form
    • The person signing the application for the Employing Provider. The signature must be that of the employing provider, unless the employing provider is a corporation, governmental entity or non-profit organization. If the employing provider is one of these three entity types and the application is going to be signed by a person other than the provider, please submit documentation that identifies the signing person’s authority to legally bind the corporation or non-profit organization or to represent the governmental entity.
  3. Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN/ITIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please visit IRS or call them at (800) 829-4933.
  4. Certificate of Professional Liability Insurance in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name of the insured, effective dates, and limits of coverage. Note: The provider’s name, as it appears on the California Physician Assistant License, must also show on the verification of the professional liability insurance.
  5. Licensed Physician Assistant’s Verification of Employment

PROCEED TO PAVE​

Last modified date: 3/23/2021 9:04 AM