Physician Pay - Test
Provider Payment
Thank you for submitting your payment online. Please complete the information below. (
* fields are required
)
First Name
*
Please enter your first name
Middle Name
*
Please enter your middle name
Last Name
*
Please enter your last name
Email Address
Provider Group
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Please enter the Physician Practice
I am submitting payment for: (please check all that apply)
Application Fees
Raleigh Initial Application Fee ($250.00)
Cary Initial Application Fee ($250.00)
Both Initial Application Fee (cost savings) ($300.00)
Reappointment Late Fee ($100.00)
Temporary Application Fee ($125.00)
Medical Staff Dues
Raleigh Initial Medical Staff Dues ($100.00)
Cary Initial Medical Staff Dues ($100.00)
Raleigh Reappointment Medical Staff Dues ($150.00)
Cary Reappointment Medical Staff Dues ($150.00)
*
Amount cannot be left blank.
If you have any questions please call Medical Staff Services at 919-350-8114.
When you click Pay Online, you will be automatically redirected to the First Data
website to securely enter your payment information.
Thank you for your payment.
WakeMed Medical Staff Services