How to start a private practice

To start a private practice, settle your employment restrictions, services, payment model, legal structure, identifiers, and malpractice coverage before the first patient visit. Then test booking, records, results, referrals, and billing as one connected process. You can investigate the plan while employed, but your contract determines which outside activities are allowed. Use written approvals and effective dates to choose an opening date you can support.

This guide is for physicians, nurse practitioners, and physician assistants planning a medical practice. Legal and agency sources were checked October 12, 2026. State rules and individual contracts need review by advisers familiar with your profession.

How do you start a private practice while still employed?

Begin with the decisions that could change the whole plan: whether outside work is allowed, where you may practice, who you intend to serve, and who will pay. Put those decisions on one page before signing a lease or buying equipment. The checklist below turns each step into a document or process you can verify.

Step	What to finish	What it unlocks
Employment review	Written advice on notice, restrictions, outside work, records, and tail coverage	A realistic location and departure plan
Care model	Patient population, services, states, visit types, and referral limits	Scope, staffing, and equipment decisions
Payment model	Insurance, cash, membership, or a defined mix	Enrollment and agreement requirements
Legal and tax setup	Permitted entity and ownership, formation where needed, and tax identifiers	Business banking and contracting
Coverage and enrollment	Malpractice confirmation and relevant payer effective dates	A supportable opening schedule
Patient operations	Booking, consent, records, results, referrals, messages, and billing	A complete first-visit workflow

The AMA's startup guide also covers location, advisers, equipment, and staffing. Use those decisions to build your own plan rather than treating a website launch as the finish line.

What should you review before resigning?

Take the actual employment agreement, amendments, and malpractice documents to counsel. Ask for a clear account of what you can do while employed and after departure. The FTC removed its nationwide Non-Compete Rule from the regulations effective February 12, 2026. Your state law and contract still need their own analysis.

Clause	Question to resolve
Notice	When can you leave, and what happens if the date changes?
Non-compete	Which work, geography, and time period does it cover?
Non-solicit	Who may contact patients or staff, and with what message?
Outside work	Can you form, advertise, or operate a side practice now?
Malpractice	Who covers prior care after departure, and who pays?
Records	How can patients request records, and who handles the transfer?

Do not use an employer's patient list as your new practice's marketing list. Agree on a lawful communication and records process first. The physician non-compete guide and tail coverage guide explain those two decisions in more detail.

How do you choose the legal structure and identifiers?

Ask a healthcare lawyer which entity and ownership arrangement your state allows for your profession, then coordinate the tax setup with an accountant. Keep the legal business name and address consistent across applications. A tax identifier, a professional license, and payer enrollment each serve a different purpose; one does not replace another.

An employer identification number (EIN) identifies the business for federal tax purposes. The IRS instructs corporations and LLCs to form with the state before applying. A National Provider Identifier (NPI) identifies a healthcare provider in standard transactions. CMS requires an NPI before Medicare enrollment.

If you are an NP or PA, confirm the separate scope, collaboration or supervision, prescribing, and ownership requirements that apply to your plan. The NP private-practice guide addresses NP-specific questions. A payer's enrollment description is not a substitute for the state practice act.

What federal startup fees can you verify?

Keep published agency fees separate from quotes for rent, legal work, equipment, insurance, and staff. The table below is a narrow federal checklist, checked October 12, 2026. It is not a total launch budget, and whether an item applies depends on the practice you are opening.

Item	Published amount or rule	Primary source
EIN	No IRS application fee	IRS EIN application
DEA practitioner registration for dispensing or instructing	$888 application fee; the table lists a three-year registration period, with a different initial-period rule	21 CFR 1301.13
Medicare enrollment	Physicians, non-physician practitioners, and their organizations do not pay the enrollment application fee	CMS enrollment guide

The same CMS guide lists a $750 fee for applicable institutional providers and suppliers in 2026. Do not assign that fee to every new medical practice. If you need DEA registration, the regulation requires approval and issuance of the certificate before the registered controlled-substance activity begins.

Use the medical practice startup-cost guide to assemble local quotes and recurring expenses. Add a payment date to each cost so you can see what comes due before revenue arrives.

Will you bill insurance, charge cash, or offer membership?

Choose the payment model before writing the patient agreement or revenue forecast. An insurance practice depends on payer enrollment and claims operations. Direct payment depends on a clear fee and service description. Membership adds ongoing access commitments. Any mix needs a written explanation of which payment covers which work.

Model	First question to answer	Guide for the next decision
Insurance	What are each payer's effective date and billing requirements?	Primary care practice
Cash at the visit	What is included, and which estimate and Medicare rules apply?	Cash-pay practice
Direct primary care	What does the periodic fee cover?	DPC practice
Concierge	What does membership buy alongside any insurance billing?	Concierge practice

Taking cash does not automatically resolve existing payer contracts or Medicare obligations. Have those reviewed before promising a payment arrangement to patients.

What must work before the first visit?

Rehearse a fictional patient's full journey. Ask a colleague to book, complete intake, receive a result, request a referral, ask a follow-up question, and understand the bill. Assign an owner to each step and a backup when that person is away. This exercise often exposes gaps that a software checklist misses.

Before opening, confirm the license and scope, malpractice start date, required registrations, privacy and consent process, record access, emergency and referral routes, and any advertised payer status. A payer application in progress is not a confirmed effective date.

For example, if an outside lab result arrives on a day you do not work, who sees it and contacts the patient? Put that answer in the operating plan before you collect the specimen.

Where can Vye Health help?

Vye Health helps providers launch, run, and grow private practices. Vye manages licensing, credentialing, malpractice insurance, and your website, and payer contracts if you want them. Vye runs bookings, billing, coding, denials, and compliance.

Bring the one-page care model, your intended schedule, and the contract questions you still need to resolve. Apply to Vye Health.

When you are ready to run the practice on Vye, see Vye Core, and pricing.