Credentials Application Process

Step 1
HSHS St. John's Hospital uses an online application process. Complete and submit form below.
Membership/Privileges Application Request Form
Provider Information 
(All fields are required)

Use this space to note any issues we need to be aware of regarding this application.
Security code

Step 2
Once St. John's Medical Staff Services receives your request form someone will send you two separate email notices (one with the link to the online application website and one with your user name and password).
Step 3
Complete and submit the online application and upload any supporting documentation (licenses, malpractice coverage, etc.). When you have completed the online application, Medical Staff Services will populate the Illinois State Credentialing Application with the information you provided. The Illinois State Credentialing Application and the Privilege request form(s) will then be sent to you for your signature.
Step 4
You may scan and email the application and privilege request form back or fax them back to Medical Staff Services at (217) 525-5673, along with any other required documentation that you did not upload at the time you completed your online application.
Step 5
There is a non-refundable application fee of $250 for Physicians, $150 for Mid-level Providers, and $300 for Health Care Assistants and Non-Physician Surgical Assistants. Please make your check out to HSHS St. John's Hospital and submit payment to:

HSHS St. John’s Hospital
Medical Staff Services
800 E. Carpenter St.
Springfield, IL. 62769

Call St. John's Medical Staff Services at (217) 757-6161 or fax (217) 525-5673.  
Learn about HSHS Medical Group