A physician based in one state who begins seeing patients located in North Dakota by video or phone runs into a licensure question fairly quickly: does an existing license cover this, or is a separate authorization needed for that patient population.
The baseline rule most states share
In most cases, the state where the patient is physically located at the time of care is the state whose licensure rules apply, regardless of where the physician's practice is headquartered. This is a common starting point across states, though the specific mechanism for compliance differs considerably.
Compact eligibility as one possible route
The Interstate Medical Licensure Compact can shorten the path to a full license in participating states for physicians who qualify. Because compact membership and program rules can shift, it is generally more reliable to check current participation directly rather than relying on a general assumption about a given state.
See current North Dakota telehealth requirements →Telehealth registration as an alternative
Where a full license or compact pathway is not the best fit, some states allow a more limited telehealth or out-of-state registration, typically restricted in scope — for example, consults, follow-up care, or a capped number of encounters per year. These registrations often carry their own renewal timelines separate from a standard medical license.
Controlled substances and DEA considerations
Prescribing controlled substances to a patient in another state generally raises questions distinct from medical licensure itself, including DEA registration requirements and state-specific rules for telehealth prescribing of scheduled drugs. These frameworks have been evolving, so treating them as a fixed, one-time check is usually not sufficient.
Compact eligibility, telehealth registration, and DEA prescribing rules are three separate questions, not one.
Consent, documentation, and audio-only visits
Many state medical boards expect documented informed consent for telehealth encounters and have specific expectations for audio-only visits versus video, particularly around when an in-person exam becomes appropriate. Reviewing these expectations alongside licensure paperwork tends to reduce downstream compliance surprises.
Requirements vary by state and change over time — always confirm current requirements directly with the relevant state board or agency before making a compliance decision.