Saint Joseph Health System Payment Gateway

Dependent Practitioner Members

If you are new to SJHS, you will need to pay your application fee(s) and your membership dues on this site.

Choose application fee(s) and/or medical staff membership dues below:

Plymouth Dependent Practitioner Membership Dues

Purchase For: *

Purchase for Self

Purchase for Other

If you are purchasing for someone other than yourself, enter that individual's name below.

First Name

Middle Name

Last Name

$100.00

Plymouth Dependent Practitioner Application Fee

Purchase For: *

Purchase for Self

Purchase for Other

If you are purchasing for someone other than yourself, enter that individual's name below.

First Name

Middle Name

Last Name

$100.00

Mishawaka Dependent Practitioner Membership Dues

Purchase For: *

Purchase for Self

Purchase for Other

If you are purchasing for someone other than yourself, enter that individual's name below.

First Name

Middle Name

Last Name

$100.00

Mishawaka Dependent Practitioner Application Fee

Purchase For: *

Purchase for Self

Purchase for Other

If you are purchasing for someone other than yourself, enter that individual's name below.

First Name

Middle Name

Last Name

$100.00

Medical Record Suspension fee

Purchase For: *

Purchase for Self

Purchase for Other

If you are purchasing for someone other than yourself, enter that individual's name below.

First Name

Middle Name

Last Name

$200.00

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Dependent Practitioner Members

Plymouth Dependent Practitioner Membership Dues

Plymouth Dependent Practitioner Application Fee

Mishawaka Dependent Practitioner Membership Dues

Mishawaka Dependent Practitioner Application Fee

Medical Record Suspension fee

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