Sutter Independent Physicians (SIP)/Sutter Medical Foundation (SMF) requires all licensed clinicians to be credentialing approved prior to rendering medical care to contracted health plan enrollees.

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* 1. Full Name:

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* 2. Title (NP, PA, AU, etc):

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* 3. CA License #:

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* 4. Gender (this is for credentialing purposes only):

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* 5. Clinician’s Mobile Phone Number:

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* 6. Clinician’s Email:

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* 7. Practice Name/Group Name:

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* 8. Primary Clinic Address (address, city, state, zip)

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* 9. Primary Supervising Physician:

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* 10. Credentialing Staff Name:

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* 11. Credentialing Staff Phone:

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* 12. Credentialing Staff Email:

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* 13. *Please ensure the above clinician contact information is accurate; an online credentialing application will be emailed directly to the clinician.

To complete this process, please submit a copy of your curriculum vitae (CV) to:

Danielle Conner at connerdv@sutterhealth.org or fax to 916-503-3751. If you would like to attend the SIP Physician Meetings, please also submit a W9 form with your individual pay to information.
Questions? 
Contact Danielle at 916-887-4911 or connerdv@sutterhealth.org.

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