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.
• Community Hospital Long Beach.
• Orange Coast Memorial Medical Center.
• Saddleback Memorial Medical Center Laguna Hills and San Clemente.

Please note: when requesting membership for more than one hospital you need only complete one application.

The Medical Staff Application process is divided into several sections:

1. Medical Staff Application
2. Application Fee
3. Medical Staff Grid
4. Privilege Forms
5. Training Modules
6. 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.

In addition, you will need to submit:

• 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.

Begin Applying Online