Professional Services Operations

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Provider Credentialing with Medicare New Rules
and Deadlines
Gil RadtkeApril 2009
Professional Services Operations
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Completing the Application

• Name on application must match the medical
  license exactly. Any name changes must be
  reported to the PSO department promptly with
  supporting documentation.
• Blue ink only.
• No highlighter, ink stamps, or white out.
• No fax copies of the application. Mail original
  forms to the PSO.

Professional Services Operations
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Required Documentation

• Must submit with the application
• Copies of current medical license
• Drivers license or passport
• NPI confirmation letter
• Signature on application must exactly match the
  signature on identification submitted.
• Medicare will only retro back 30 days from the
  received date of the application.

Professional Services Operations
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Help or Additional Information
Aimee Quach aquach_at_stanfordmed.org 650-498-7103 T
heresa Pasquinelli tpasquinelli_at_stanfordmed.org 65
0-498-5710 Maria Terrazas mterrazas_at_stanfordmed.o
rg 650-498-5776
Professional Services Operations