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.
Enter security code:
Security code

Step 2
Once Medical Staff Services receives your request form you will receive an email with a link to the online application website, your username and password and a list of the applicable forms required. 
Step 3
Complete and submit the online application and upload any supporting documentation (licenses, malpractice coverage, etc.), including the Illinois State Credentialing Application and privileges forms. You may also scan and email documentation to Medical Staff Services or fax to (217) 525-5673 (St. John’s), (217) 464-3144 (St. Mary’s) or (217) 324-8670 (St. Francis and Good Shepherd).
Step 4
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
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
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.  

Learn about HSHS Medical Group