Provider Resources

Provider Referral Forms

These frequently requested referral forms are provided for the convenience of community providers.

Hospital Affiliation Verifications

For hospital affiliation verifications, please access NAMSS resources.

For instructions on using NAMSS PASS, please click here.

Medical Records

Contact Medical Records for patient documents such as medical history/chart.

Phone: (360) 417-7136
Fax: (360) 417-7674

Medical Staff Services

Sally Rowland, CPMSM, CPCS
Credentialing Specialist
Phone: (360) 417-7711

Marisa Bleck
Credentialing Specialist
Phone: (360) 417-7336

Fax: (360) 417-7082
Office: 939 Caroline Street, Port Angeles, WA 98362
Hours: Monday – Friday, 7:00 am – 3:30 pm

Payer Enrollment

Joanna Weber
Director, Revenue Cycle Management
Phone: (360) 417-7796
Fax: (360) 417-7342

Stacy L. Nikodym
Credentialing, Contracting and Reimbursement Analyst
Phone: (360) 565-9237
Fax: (360) 565-9241
Office: 519 S. Peabody Street, Suite 4 or PO Box 850, Port Angeles, WA 98362
Hours: Monday – Friday, 7:30 am – 4:00 pm