Medical Staff Services
Thank you for considering joining the medical staff at Saint Mary’s Hospital!
The Medical Staff of St. Mary’s Hospital credentials practitioners in:
- Advanced Practice Registered Nurses
- Certified Registered Nurse Anesthetists
- Certified Nurse Midwives
- Physician Assistants
Application Request Form
When you complete and return this form, your request will be reviewed by the Chair of the Department granting privileges. Upon primary approval, we will send to you via email, fax or mail the full Medical Staff Application.
Should you prefer to print and fax or mail the application request to Saint Mary’s Medical Staff Office, please download the PDF version.
The Medical Staff Application Process
The Medical Staff Application is the document which includes all information necessary for primary source verification for your credentialing and privileges at Saint Mary’s Hospital. Please take care to review and complete the entire form including in your signature upon completion. For all hospitals this form acts as an affidavit indicating the veracity of all statements supporting the granting of privileges.
The credentialing process at Saint Mary’s is efficient and concise. Once your request for application has been reviewed and approved, you will be sent a full credentialing packet. When completed, meaning all documents and signatures are included on file and all primary source verification has been fulfilled, your application will be forward to the hospital’s Credentialing Committee for approval. Then over the next two or three weeks reviewed and approved by first the Medical Executive Committee and finally the Hospital Board of Directors. In total, the approval process, beginning with the Credentials Committee approval, will take approximately four weeks.
The Credentials Committee currently meets on the fourth Friday of the month, and typically credentials are approved on or about the fourth week of the following month. Using this timeframe as a guide, you will be able to accurately determine a potential date for receipt of your hospital privileges. For more information regarding Physician Relations Services, please contact Mary King, Medical Staff Coordinator at (203) 709-6421 or firstname.lastname@example.org.
Meet Our Department Chairs
- Anesthesiology: Keith Lipsitz, M.D.
- Dentistry: Richard Putnam, DDS
- Emergency Medicine: Peter Jacoby, M.D.
- Medicine: Jason Ouellette, M.D.
- Obstetrics and Gynecology: S. Mark Albini, M.D.
- Pathology: William Frederick, M.D.
- Pediatrics: Lata Jayanthi, M.D.
- Psychiatry: Azhar Imam, M.D.
- Radiology: Bipinchandra Jagjivan, M.D.
- Surgery: Philip Corvo, M.D.