Medical Staff House Staff Orientation Manual - Montefiore Medical ...

MEDICAL STAFF CREDENTIALING OFFICE
Director, Provider Services & Network Contracting 914-377-4668
Michael Dowling
914 -377-4794 Fax
Director, Credentialing 914-377-4605
Rose Richter
914-377-4791 Fax
Assistant Director, Provider Information 914-377-6021
Justina Marrone
914-709-0386 Fax
The Credentialing Office is responsible for the Appointment and Reappointment of all attending
physicians and employed allied health professionals for Montefiore Medical Center and the
Montefiore Independent Provider Associations (MIPA).
Privileges and Appointment to the Medical Staff
Applications to the Medical Staff and Montefiore IPA(s) can be obtained through the
Department Chairman’s Office. All Medical Staff appointments are provisional for one year and
all medical staff are required to be reappointed every two (2) years.
Clinical departments are responsible for assembling the required credentialing documents
necessary for appointment prior to submission of the application package to the Credentialing
Office. Required documents include:
• Current curriculum vitae
• Delineation of Privileges (Completed by applicant and signed by the chairman)
• Current NY State License registration, signed by physician
• NYS Infection Control Certification
• DEA certificate
• Current malpractice insurance certificate
• Recommendation and appointment letter from Department Chairman
• Confidential Medical History and Examination
• Completed application signed by the Department Chairman
• Letters of recommendation and verification of education, training and clinical competence
• Health Plan and government programs enrollment forms
The Credentialing Office is responsible for all verifications including sanction checks,
affiliations, state licensure, DEA registration and others as required by regulatory agencies. The
Credentialing Office will be responsible for ensuring that all appropriate signatures are obtained
and that the completed file is processed and approved according to Montefiore Medical Center’s
Medical Staff By-Laws, Rules and Regulations.
Medical Staff Reappointment
Montefiore Medical Center Medical Staff members are subject to reappointment every two
years. At the time of reappointment each physician/dentist is asked to:
• review and update a General Information Profile Form which outlines biographical and
practice information
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