Medical Staff Services
Applicant Links
Initial Credentialing and Privileging: What to Expect
Electronic Application - MD App (account required)
Helpful External Links
Application for DEA Registration
National Provider Identifier (NPI) Application Instructions
Washington State Physician/PA Licensing Forms
Washington Physician Assistant Delegation Agreement
Washington State Department of Health – License application, renewals, FAQ’s
MSS Review Links
Committee / Chief Review (Virtual Committee)
Medical Staff Leadership
FAQs
How Do I Change My Last Name with Medical Staff Services?
If your last name has changed, you must first make this change on all Washington State licenses, your NPI and DEA registration (if applicable).
Once we can verify this has been completed, a name change will be generated within our office and with Cerner.
NOTE: Name changes through Human Resources (for badging, payroll or other employment activities) must be done separately.
How to Change Last Name with NPPES (NPI Registration)
Step 1: login to https://nppes.cms.hhs.gov/IAWeb/login.do
- Click on My Profile
- Change last name
Step 2: https://nppes.cms.hhs.gov/#/ (these links look the same, but lead to different forms)
- Log in using same username/PW as above.
- Under Manage Provider Information, find the “Pencil” icon, and click on it.
- This leads to a 7 page form, change your name on page 1, and then sign and submit on page 7.
- Await confirmation email (change should occur in 24 hours if there are no issues, otherwise can take up to 30 days if more information needs to be verified).
Hospital Affiliation Verifications
To pull a verification from MD-Query, go to MD-Query (www.mdquery.com/evergreen)
Login: evergreen
Password: query
If no letter is available for the practitioner you are verifying, please fax your request with a release to 425.899.1898 or email to us at evgmedstaff@evergreenhealth.com.
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