Please complete the below form and click submit.  In addition, please email a statement of interest along with a current CV to Natalya Myrmyr at MyrmyrN@sutterhealth.org.

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* 1. Physician Full Name & Title (MD, DO, DPM)

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* 2. CA License No.

Please note: The following specialties are compensated under a Capitation Methodology: Allergy, Cardiology, Dermatology, ENT, Gastroenterology, Ophthalmology, Podiatry, and Urology.

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* 3. Primary Specialty

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* 4. Are you currently Board Certified?

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* 5. Contact Information

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* 6. Multiple Practice Locations?

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* 7. Do you currently have Sutter hospital privileges?

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* 8. If yes, which Sutter Hospitals do you have privileges?

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* 9. Do you need Sutter hospital privileges? If yes, please select facility(s).

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* 10. If you are a solo provider, who provides your call coverage?

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* 11. **I understand this submission of interest is NOT authorization to render medical care to contracted health plan members.

Before you submit, please note you must email a statement of interest along with a current CV to Natalya Myrmyr at MyrmyrN@sutterhealth.org.

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