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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 issues facing DaVita mainly relate to legal controversies and scrutiny over its services and operations. Some patients and employees have raised concerns regarding quality of care and workplace practices. If you are seeking formal documents or evidence, the DaVita Credentialing Request Form can assist in submitting your inquiries.
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