Provider Request for Application

St. Charles Health System

Help Text

Thank you for your interest in St. Charles Healthcare.  We will need some key pieces of information from you to evaluate your request of privileges/affiliation with our organization.   Please provide the information below and our office will be in touch with you with next steps.

**Please provide your CAQH information in the areas identified below.  

Initial Application Processing Fees are as follows:

*  St. Charles Bend/Redmond (primary facility) - $500
*  St. Charles Madras or St. Charles Prineville (primary facility) - $200
*  Additional Facility - $100 

Please send check to: 
St. Charles Healthcare System
Attn:  Medical Staff Services
2500 NE Neff Road
Bend, OR 97701

Should you have any issues, please contact our office at 541-706-6315 or email the credentialing team at credentialing@stcharleshealthcare.org.

Please select the statement that best describes your status and fill in the application request form that appears on the page.

*Current Status

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