Online Medical Staff Application
Medical Staff Application
Thank you for your interest in applying to the MemorialCare Medical Staff. Our Medical Staffs include those at:- Long Beach Memorial Medical Center.
- Miller Children's Hospital Long Beach.
- Orange Coast Memorial Medical Center.
- Saddleback Memorial Medical Center Laguna Hills and San Clemente.
The Medical Staff Application process is divided into several sections:
- Medical Staff Application
- Application Fee
- Medical Staff Grid
- Privilege Forms
- Training Modules
- Mailing Instructions
Completing an Online Medical Staff Application
In order to complete the MemorialCare online medical staff application and/or receive medical staff membership, you will need to provide information related to the following items:
- Current licensure in California as a physician, dentist, or podiatrist (Orange Coast Memorial Medical Center only: clinical psychologist).
- Board Certification or evidence of active participation in the Board certification process*.
- National Provider Identification (NPI Number).
- DEA certification.
- X-Ray/Fluoroscopy certification (if applicable to your specialty).
- Malpractice Insurance Certificate and names of any other insurance carriers during the last seven years.
- Previous work experience.
- Education and training.
- All supporting forms (Appendix A-E) - Background Check Release, Code of Behavior Acknowledgement, Confidentiality And Conflict Of Interest, Pharmacy Signature Sheet, Physician Acknowledgment Form, Epic EMR training and HIPAA test completion.
- Evidence of current screening for tuberculosis.
- An application fee of $400.00 for primary facility membership and $100.00 for each additional facility.
Processing Time
Our average processing time is 60 - 90 days following receipt of a completed application.
