Welcome to Physician Performance LLC
Please choose from one of the forms below in order to add, change or terminate any providers within your group, or add/change/terminate a group.
membership forms
New to Physician performance
to Change information or terminate a physician from your group
Adding a physician to a group already participating
Applications to join and forms for your physicians to apply if you are not a single provider TIN
Adding a physician to a group already participating
to Change information or terminate a physician from your group
Adding a physician to a group already participating
If your group is already participating, use this form to apply to add physicians to your group
to Change information or terminate a physician from your group
to Change information or terminate a physician from your group
to Change information or terminate a physician from your group
Use this form to change demographic, non-demographic information or terminate a physician from Physician Performance who is no longer a part of your group. We have also posted files to help you update CAQH with new information.
Forms for application of new group/tin
If you are a new group/TIN requesting to join Physician Performance, please fill out the correct form:
- -group with single provider only needs to fill out the first application (....for single provider) and the W-9 form
- -groups with multiple providers should fill out the appropriate application based on your specialty and the W-9 form, along with the "New survey for all physician applicants" for each physician in the group
- All fields must be completed in order to be considered final.
Application Request for PPLLC Participation for single provider 9-9-21 (pdf)
DownloadApplication Request for PPLLC Participation_9-9-21 (pdf)
DownloadApplication Request for PPLLC Participation9-9.2021 - OBGYN (pdf)
DownloadApplication Request for PPLLC Participation_9-9-21 - Dermatology (pdf)
DownloadApplication Request for PPLLC Participation_9-9-21 - Podiatry (pdf)
DownloadNew survey for all physician applicants 9-7-21 (pdf)
Downloadblank w9 form (pdf)
DownloadAdding a physician to a group already participating
If you are a group already participating in Physician Performance, please fill out an application form for each physician. All fields must be completed for the application to be considered final.
New survey for all physician applicants 9-7-21 (pdf)
Downloadform to make changes or terminate a physiciaN
Please fill out the attached form to make any changes or to terminate a physician from participation in your group.
Demographic and Non-demographic changes can include the following:
- adding a practice address that is new to your organization,
- adding or changing your TIN,
- changing the scope of services provided at your practice, or
- changing the status of a physician between PCP and specialist
PPLLC ChangeTerm Form 4.7.2025 (pdf)
DownloadCAQH Overview
We have also posted files to help you better understand how to update CAQH with updated physician information once you are notified that the physicians are approved by Physician Performance governance.