Initial Appointment Services

MPR conducts credentials verification of physicians, dentists and independent and dependent allied health practitioners.

The initial appointment application process meets all accreditation and licensing requirements of the TJC, DNV, HFAP, CMS and AAAHC.

MPR provides sample specialty-specific clinical privileges.


  • Employment
  • State license to practice and/or certification and/or registration
  • ABMS board certification
  • Medical school graduation
  • Education of foreign medical graduates
  • Internship, Residency and Fellowship completion
  • Hospital affiliations
  • Malpractice insurance claims history
  • National Practitioner Data Bank (NPDB) continuous query services
  • Sanctions against licensure
  • Medicare/Medicaid sanctions
  • Professional references

All data is stored electronically and reproducible in a secured database available for retrieval.


You will need to gather the following documents to complete an initial appointment application:

  • Current Certificate of Insurance
  • Kansas Healthcare Stabilization Fund (MD, DO, DC, DPM, CRNA,  only)
  • DEA certificate (MD, DO, DDS, PA, ARNP only)
  • Board certificates or letter(s) of eligibility (MD. DO only)
  • Copy of residency/fellowship certificates of completion (MD, DO only)
  • Curriculum Vitae or resume including complete professional work history and education (Resumes and CVs are considered supplements to the application and cannot be submitted in lieu of a completed application.)
  • Photographs (one for each entity at which you are making application)
  • Line listing of all post-graduate CME activities which you have attended and for which you have received credit in the past two years.  Do not send copies of certificates the hospital surveyors require a line listing to compare to clinical privileges. Line listing must include date, title of course, number of hours and category.
  • NCCPA certificate (PAs only)
  • NBCRNA certificate (CRNAs only)
  • Education Council for Foreign Medical Graduates Certificate (as applicable)
  • Discharge papers, if service in the US Armed Forces
  • Residency log of procedures (If a residency graduate within the past year)
  • Military discharge, i.e. DD214 (as applicable)
  • Government issued photo ID (driver’s license, passport military ID.  Photo must be easily recognizable.