Credentials Application Process


Step 1
HSHS facilities use an online application process. Complete and submit form below.
 
Membership/Privileges Application Request Form
Provider Information 
(All fields are required)



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

 
Step 2
Once Medical Staff Services receives your request form you will receive two separate email notices (one with the link to the online application website and one with your username and password).
 
Step 3
Complete and submit the online application and upload any supporting documentation (licenses, malpractice coverage, etc.). When you have submitted 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, privilege request form and any other required documentation you did not upload when you complete your online application to Medical Staff Services.  You may also fax these items to (217) 525-5673 (St. John's), (217) 464-3144 (St. Mary's) or (217) 324-8670 (St. Francis and Good Shepherd).
 
Step 5
There is a non-refundable application fee for each facility. Please make out your check to the facility to which you are applying for the appropriate amount and mail it to the address below. 
 
HSHS St. John's Hospital
Medical Staff Services
800 E. Carpenter St. 
Springfield, IL  62769
Physicians: $250
Mid-Level Providers: $150
Health Care Assistants and Non-Physician Surgical Assistants: $300
 
HSHs St. Mary's Hospital
Medical Staff Services
1800 E. Lake Shore Dr.
Decatur, IL  62521
All providers: $225
 
HSHS St. Francis Hospital
Medical Staff Services
1215 Franciscan Dr.
Litchfield, IL  62056
All providers: $200
 
HSHS Good Shepherd Hospital
Please mail to St. Francis Hospital 
All providers: $100
 
 
Questions?
Call St. John's Medical Staff Services at (217) 757-6161 or fax (217) 525-5673.  
Call St. Mary's Medical Staff Services at (217) 464-5215 or fax (217) 464-3144.
Call St. Francis Medical Staff Services at (217) 324-8791 or fax (217) 324-8670.
For Good Shepherd, call or fax St. Francis's Medical Staff Services at the numbers above.  

 
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