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The full launch roadmap sequences everything with comfortable slack. This is the compressed version: four months from decision to first patient. It works because almost nothing on the list actually depends on the thing before it, the trick is starting the slow tasks on day one and letting everything else run in parallel.
The one thing that does not compress is payer credentialing, 90 to 180 days per payer, and it only starts once you have an entity, an EIN, and a Type 2 NPI. A 4-month launch means you will likely open before you’re in network. Plan for it (see “Opening before the payers are ready” below) rather than letting it surprise you.

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Month 1, Create the machine

Everything this month exists to unblock credentialing and money. The entity and identifiers, in the first two weeks. Form the entity (which one), get the EIN the same day the formation comes back, then the Type 2 NPI. Not a physician yourself? The ownership structure changes, read Owning a practice when you’re not a physician before forming anything. Start credentialing the moment the NPI exists. CAQH profile, payer applications for your top 4-6 payers, and Medicare via PECOS if you’ll see Medicare patients (Get credentialed). Every day of delay here is a day added to the end. The money. Loan applications go out this month too, underwriting takes 4-8 weeks and you’ll want funds before the buildout invoices arrive (Get a practice loan). Size the ask with the startup cost calculator. Open the bank accounts as soon as the EIN exists, operating, tax reserve, and payroll (structure, setup). Every enrollment and application downstream asks for these details; locking them early means never re-doing an EFT form.

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Month 2, Build the container

Space. Sign the lease and start buildout. This is the month with the most external dependency (landlords, contractors, permits), anything you can do to shorten it, spend money on. An existing clinical space that needs paint beats a shell that needs plumbing. Systems. Pick the EHR/PM (how to choose) and the clearinghouse together, they determine how claims leave and how remittances come back. Get the demo account this month, not opening week. People. Post for front-desk and clinical staff now; you want them hired in month 3 so opening week isn’t their first week.

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Month 3, Wire the money

Payer follow-up, weekly. Credentialing applications rot without pressure. One owner-hour per week chasing every open application measurably shortens the tail. EFT/ERA enrollment for every payer that has contracted, as contracts come back, portal registration, deposit account, remittance delivery (the payer setup playbook, and the per-payer directory for exact steps). The patient-payment side. Choose and set up your POS system, even an insurance-heavy practice collects copays and deductibles from day one. Payroll, malpractice, and the compliance floor. Payroll provider running before the first hire’s first check; malpractice bound before the first patient; HIPAA basics (BAAs with every vendor that touches PHI) done in an afternoon, not discovered in an audit.

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Month 4, Rehearse, then open

Test the full loop with fake patients. Schedule → intake → chart → code → claim → clearinghouse acceptance. Run a real card on the POS and void it. Send a test claim to your largest contracted payer and watch it hit accepted status. The practices that skip the rehearsal find the broken link in the revenue chain 45 days after opening, when the first denials arrive. Soft-open in week 3 with a light schedule, friends-and-family volume that exercises every system while mistakes are cheap.

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Opening before the payers are ready

If you open in month 4, some payer contracts will still be pending. Your options, roughly in order of preference: see those patients out-of-network with a clear cost conversation (works where you have out-of-network benefits to bill); run cash-pay with superbills until contracts land (how superbills work); or in some states and specialties, bill under a supervising/credentialed colleague, this one is regulated and payer-specific, so confirm the rules before relying on it. What you should not do is hold claims and hope: timely-filing clocks run from date of service.

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What this plan assumes

A straightforward single location, financing that clears underwriting, and no buildout surprises. Buying an existing practice moves faster (the machine already exists, see Buy a practice); heavy construction or a hospital-adjacent specialty moves slower. When in doubt, the full roadmap shows the same tasks with the dependencies drawn out.