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MEC Recommendations – January 2011.
Definitions: A=Active C=Courtesy PC= Provisional Aff: Affiliate Page 1 of 2
A. Request to add Psychiatric NP to the Psychiatry Privileges forms
Attachment 1
B. New Medical Staff Members
Katharine Ballinger, MD Psychiatry/Psychology
Omri Berger, MD Psychiatry/Psychology
Ryan Estevez, MD Psychiatry/Psychology
Bradley Glenn, MD Diagnostic Imaging
Rebecca Render, DO Family Medicine
Anita Wang, MD Emergency Medicine
C. Request for Additional Privileges
Thomas McCoy, MD Emergency Medicine
Chiu Tung, MD Anesthesia
Michelle Wong, MD Family Medicine
D. Request to Change Primary Department (FM) to Emergency Medicine
Maya Shaw, MD
E. 12-Month Provisional Status - Request to extend for an additional 3-12 Months
Jenya Dvorkin, NP Ob/Gyn
Dayna Parish, MD Pediatrics
Christina Seed, DO Family Medicine
George Vandermark, MD Pathology
F. Advance to Non-Provisional
Madeline Andrew, MD Psychiatry/Psychology
Hiya Asrani, MD Pediatrics
Leslie Gillis, NP Family Medicine
Richard Makman, MD Psychiatry/Psychology
Natasha Pinto, MD Family Medicine
Annie Thomas, MD Psychiatry/Psychology
G. Biennial Reappointments
Philipp Banwart, MD Family Medicine A
Peter Broderick, MD Family Medicine C
James Carpenter, MD Pediatrics A
Grace Cavallaro, MD Ob/Gyn A
Daniel Forkin, MD Psychiatry/Psychology P/C
Susan Feierabend, MD Ob/Gyn A
Imtiaz Ghori, MD Pediatrics A
Estela Hernandez, MD Emergency Medicine A
Anthony Jones, MD Internal Medicine C
Varujan Keledjian, MD Internal Medicine C
Paul Kwok, DO Anesthesia A
T. Rich McNabb, MD Family Medicine A
William Peterson, MD Emergency Medicine A
MEC Recommendations – January 2011.
Definitions: A=Active C=Courtesy PC= Provisional Aff: Affiliate Page 2 of 2
Michael Price, MD Diagnostic Imaging C
David Reedy, MD Emergency Medicine A
Paul Reif, MD Internal Medicine A
Vinod Sharma, MD Psychiatry/Psychology A
Lisa Wang, MD Psychiatry/Psychology A
Gila Wildfire, MD Family Medicine A
Peter Won, MD Diagnostic Imaging A
H. Biennial Renewal of Privileges
Christine Costa, NP Ob/Gyn Aff
Jenya Dvorkin, NP Ob/Gyn Aff
Patricia Hill, NP Family Medicine Aff
Phyllis Howard, NP Family Medicine Aff
Anthony Longoria, NP Family Medicine Aff
Paul Manaut, NP Family Medicine Aff
I. Voluntary Resignations
Christopher Benitez, MD Psychiatry/Psychology
Nazia Choudhury, MD Anesthesia
David Jablons, MD Surgery
Jacob Meyer, MD Family Medicine
Richard Schwarz, MD Psychiatry/Psychology
Attachment 1
Contra Costa Regional Medical Center
Privileges Request Form
Practitioner:___________________________________
PSYCHI
Page 2 of 1
01/2011
Department(s) Number
Privilege Description
D=With Direct Supervision
C=With Consultation
U=Unrestricted D/C/U Training/ Education Experience Current Competence 9 Requested 9 Granted D=Denied P=Pending CNM=Criteria Not Meet
PSYCHIATRY
Psychiatry - Expanded Outpatient
PSI
2
Complex outpatient psychiatric care as above...
14 - 17 years
C
Psyi or
Psychiatric NP
1 yr.
N/A
U
Psyi
2 yrs.
1 yr. in
last 4
yrs.
PSI
3
Complex outpatient psychiatric care as above...
18 - 59 years
C
Psyi or
Psychiatric NP
1 yr.
N/A
U
Psyi
2 yrs.
1 yr. in
last 4
yrs.
GER
PSI
4
Complex outpatient psychiatric care as above...
> 50 years
C
FP or IM or Ger
or Psyi or
Psychiatric NP
1 yr.
N/A
U
Ger or Psyi
2 yrs.
1 yr. in
last 4
yrs.