Submitting an application
The process for submitting an application is easy. Please print out and follow these guidelines and required forms.
Read and print the letter of instruction.
Follow the link to the Illinois Department of Public Health (IDPH) website to download and complete the state-mandated application form at www.idph.state.il.us/about/credentialing.htm
Complete the Advocate Supplement Form and Attestation which authorizes the Advocate Healthcare Credentials Verification Office to obtain information on you and verify your credentials.
Complete the privilege sheet for your surgical specialty:
- Anesthesia
- Dental
- Gastroenterology
- General Surgery
- Gynecology
- Hand Surgery
- Neurosurgery
- Ophthalmology
- Oral & Maxillofacial
- Orthopedic Surgery
- Otolaryngology
- Pain Management
- Plastic/Cosmetic Surgery
- Podiatry – Level I & II
- Urology
If you are not currently on staff or in the process of applying to Edward Hospital, complete the Admission Referral Form. You must identify and obtain the signature of a physician who has admitting privileges at Edward Hospital and who agrees to assume responsibility for admitting your emergent patients from Naperville Surgical Centre to Edward Hospital.
Complete the Designation of Advocate Credentials Verification Office (CVO) as Professional Liability Insurance Certificate Holder which authorizes your professional liability insurance carrier to send the Advocate Healthcare Credentials Verification Office verification of your professional liability coverage showing dates of coverage, amounts of coverage and any limit in coverage, and to be notified of the amount of your coverage and any future changes in your insurance status.
Sign and date the forms. Dates of signature on the State of Illinois Health Care Professional Credentialing and Business Data Gathering Form and the Advocate Supplement Form must match.
Mail all originals to Janis Licari at 1263 Rickert Drive, Naperville, IL, 60540.
Once the verified application is returned to our office, we will contact you to arrange for your personal interview with our Credentials Committee.
Mission Statement
To effectively provide appropriate, safe, efficient and cost-effective care to patients requiring elective ambulatory surgery
Hours
Monday–Friday
6:05 am to 5:00 pm
Contact us
Naperville Surgical Centre1263 Rickert Drive
Naperville, IL 60540
630.305-3300 | Fax 630.305-3301
Advance Notification to Patients
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Staff
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