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Get Davita Credentialing Request Form
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How to fill out the DaVita Credentialing Request Form online
Filling out the DaVita Credentialing Request Form online is a crucial step for practitioners seeking to be credentialed with DaVita. This guide will walk you through each part of the form, ensuring you complete it accurately and efficiently.
Follow the steps to successfully complete the DaVita Credentialing Request Form.
- Click ‘Get Form’ button to obtain the form and access it in your preferred format.
- In the 'Requestor Information' section, provide your name, title, email address for the application submission, and the date you completed this section.
- Proceed to 'Practitioner Demographics', entering the first and last name, middle name, and professional designation. If you are currently credentialed with DaVita, you may skip to Section IV.
- Fill out the required fields, including Date of Birth, Social Security Number, Gender, State License Number, License Expiration Date, UPIN, NPI Number, and Practitioner Email Address if it differs from the one in Section I.
- Next, navigate to 'Practice Information'. Here, input the practice name, street address, city, phone number, state, fax number, and zip code.
- In 'Facility Requests', indicate any additions or removals of facilities from the practitioner's profile. Provide facility number and names, and specify the covering physician, medical director, city, state, and the change you are requesting.
- Once all sections are filled in, check your entries for accuracy. Then, save your changes and choose to download, print, or share the completed form as required.
Complete your DaVita Credentialing Request Form online today to ensure a smooth credentialing process.
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The DaVita dialysis scandal involves allegations regarding improper procedures and billing practices. These claims suggest that the company has engaged in unethical conduct that affects patient care. Those interested in understanding the details can benefit from utilizing the DaVita Credentialing Request Form, which can aid in gathering necessary information.