Free Resource Guide

Texas Medical Practice
Startup Checklist

A comprehensive, phase-by-phase guide to launching your medical practice in Texas — from licensing through opening day.

8 Phases|50+ Action Items|Updated 2026

Important: Entity Formation

Texas physicians cannot form a Professional Corporation (PC). Your only options are a PLLC or PA. View the full entity types chart.

Phase 1: Licensing & Credentials

Obtain Texas Medical License from TMB (Texas Medical Board)CriticalApply for DEA registration (if prescribing controlled substances)CriticalObtain NPI (National Provider Identifier) numberVerify board certification statusObtain malpractice insurance (occurrence vs. claims-made)Research county/city business permits and requirements

Phase 2: Business Entity Formation

Choose entity type: PLLC or PA (PCs prohibited for physicians in Texas)CriticalSelect and reserve your entity name with Texas SOSFile Certificate of Formation with Texas Secretary of StateDraft Operating Agreement (PLLC) or Bylaws (PA)Obtain EIN (Employer Identification Number) from IRSOpen a business bank account (separate from personal)Register with Texas Comptroller for franchise tax

Phase 3: Insurance & Risk Management

Secure professional liability (malpractice) insuranceCriticalObtain general liability insuranceWorkers' compensation insurance (required if employees)Business property insuranceCyber liability insurance (HIPAA data breach coverage)Disability and life insurance (key person)

Phase 4: Credentialing & Payer Enrollment

Credential with Medicare (CMS-855I and CMS-855B)CriticalEnroll with Texas Medicaid (if applicable)Credential with commercial insurance payersApply for hospital privileges (if applicable)Register with CAQH ProView (universal credentialing database)Allow 90-120 days for credentialing — start early

Phase 5: Office Setup & Compliance

Negotiate and execute office lease (have attorney review)CriticalSelect and implement EHR/EMR system (ONC-certified)Implement HIPAA compliance program (Privacy Officer, policies, BAAs)Set up practice management and billing softwareEstablish OSHA compliance (bloodborne pathogens, hazard communication)Order medical supplies, equipment, and furnitureSet up phone system, internet, and IT infrastructure

Phase 6: Staffing & HR

Hire key staff (office manager, medical assistant, billing)Draft employment agreements and offer lettersCreate employee handbook and policiesSet up payroll system and workers' compConduct background checks and license verificationsSchedule staff training (HIPAA, OSHA, EHR)

Phase 7: Financial & Tax Setup

Establish accounting system (QuickBooks, Xero, etc.)Hire a CPA familiar with medical practicesSet up retirement plan (SEP-IRA, Solo 401k, or defined benefit)Establish billing and collections proceduresPlan for estimated tax payments (quarterly)Consider asset protection strategies for personal wealth

Phase 8: Marketing & Launch

Build professional website with online schedulingClaim Google Business Profile and online directoriesAnnounce opening to referral sources and communitySet up patient portal and intake formsPlan grand opening and community outreachImplement patient review collection system

Need Help Getting Started?

As a dually licensed Attorney and CPA with 29+ years serving Texas medical professionals, Darryl V. Pratt can guide you through every phase of your practice launch.

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Texas Medical Practice Startup Checklist