Initial Credentialing and Privileging: What to Expect
Electronic Application - MD App (account required)
Application for DEA Registration
National Provider Identifier (NPI) Application Instructions
Washington State Physician/PA Licensing Forms
Washington State Department of Health – License application, renewals, FAQ’s
Committee / Chief Review (Virtual Committee)
Medical Staff Officers & Office Staff
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
Step 2: https://nppes.cms.hhs.gov/#/ (these links look the same, but lead to different forms)
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.