IM Requirements

Unrestricted License
    You need to have your internship certificate to do this -- which means all of your hours and patient logs from internship year need to be handed in.
    Go to: www.dos.state.pa.us
    Click on:
                
- become a licensed healthcare professional
                - osteopathic medicine
                - licensure information
                - board forms

    This will cost you $45 the first time you apply
    This license is renewed every EVEN number year on Oct 31st.
    The renewal fee is $220 -- does not matter if you get it on Oct 30th, you will still owe $220 so time it appropriately.

NPI Number
    Go to: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions
    Click on:
                - Sole Provider (not group!)
                - Fill out the forms - use OT# if you do not have an OS#
                - Save the confirmation they send you -- you will need it for your medicare application
                - this online process takes about 5 min (ie NPI number is sent to your Email within moments)

UPIN Number
    No longer needed!  NPI takes its place.

DEA Number
    Go to: https://www.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp
    Fee is $731
    Select: Practitioner
    License lasts about 3 years
To change your address: https://www.deadiversion.usdoj.gov/webforms/jsp/regapps/common/updateLogin.jsp

Medicare Application
    You will need this as you get close to graduation -- the information is somewhat employer-dependent so if you know where you are going, get started early.
   
    Go to: http://www.asipp.org/documents/CMS855i_000.PDF
    This is the basic medicare form.  You can Google search other forms you  may need -- depending on if you are a single vs group provider and electronic transfer payment forms.  The form #'s are spread throughout the document.

Things You Need To Turn In To the ACOI (www.acoi.org)

1) Resident Patient Evaluation
    This needs to be done before the end of your second year - get it back and MAKE A COPY for yourself!  The form can be found on the ACOI website under residency training -> core competency evaluations.

2) Continuity Clinic Evaluation
    This needs to be done twice a year!  Take it to your office of declaration and have it filled out.  Again, MAKE A COPY for yourself!  Found under core competency evaluations as above.

3) Annual Program Report
    Done online.  Must be submitted between June 30th and July 31st.  If you don't, you will be fined $150 per the resident requirement paperwork.  A notice is usually sent to you by the ACOI informing you it's time.

4) Time Cards and Service Evaluations
    Complete online.

5) Office Logs
    You need to keep a log of the patients you see.  If you don't know what to write, a suggested format can be found on the ACOI website under resident requirements (ie patient initials/diagnosis/date seen).

6) Procedure Certificate Logs
    You should be keeping index cards of all of your central lines, arterial lines, intubations, etc.  Make a face sheet (ie word/excel).  Turn in copies of your cards to GME to get your Certification Letter from Dr Sesso.  Many places require proof of your procedures so KEEP ALL OF YOUR ORIGINAL CARDS.

OMM Module
    No longer required.

IM Board Certification
Website: www.aobim.org

Examination Fee: $800.
Additional Late Registration Fee: $200. 
Eligibility: Completion of Residency training by August 31, 2013.

Earliest time to apply to take the Exam: October 1, 2012.
Exam Date: September 9, 2013.
Application Deadline (application and fee on their desk!): February 1, 2013.
Late registration deadline is April 1, 2013. 

Candidates may not register with the Pearson VUE computer company until the Board approves the candidate's application and a registration number is provided to the candidate.  The registration number will be provided on the first week of June.


Application materials may be obtained by writing to:
American Osteopathic Board of Internal Medicine
Attn: Gary L. Slick, D.O.
1111 West 17th Street
Tulsa, OK 74107
E-Mail: aobim@mail.com

More available on the ACOI website under certification tab.

/revised 01.24.13