NPIMap

Individual provider Active NPI

Katie Tetzlaff, PA-C

  • Physician Assistant
  • Brookings, SD
National Provider Identifier
1104371897
Registry record updated Jul 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
400 22ND Ave
Brookings, SD 57006-2450
Phone
(605) 697-9500
NPI assigned
Aug 23, 2016
Sex
Female
Sole proprietor
No

Organizations & group practices 27

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 27

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of Brookings 112 clinicians
Rural Health Care Inc 156 clinicians

Practice addresses (Care Compare)

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 692-6351

310 22ND Ave
Brookings, SD 57006-2474
Phone (605) 697-9500

400 22ND Ave
Brookings, SD 57006-2450
Phone (605) 697-9500

Hospital & facility affiliations

  • Brookings Health System Hospital, Brookings, SD, CCN 430008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20210421001753 SD Practitioner - Physician Assistant 6800175407 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1294SDMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
City of Brookings Current Accepting new patients
Sanford Health Network CurrentSince Oct 22, 2016 Accepting new patients
Sanford Health Network CurrentSince Oct 22, 2016 Accepting new patients
City of Brookings CurrentSince Apr 26, 2021 Accepting new patients
City of Brookings CurrentSince Apr 26, 2021 Accepting new patients
Rural Health Care, Inc CurrentSince Apr 26, 2021 Accepting new patients
Rural Health Care, Inc CurrentSince Apr 26, 2021 Accepting new patients
Avera McKennan Past Accepting new patients
Rural Health Care, Inc. Past Accepting new patients

Locations

249 5th St E
Tracy, MN 56175
Phone (507) 629-3520

1018 6th Ave
Worthington, MN 56187
Phone (507) 343-6100

1680 Diagonal Rd
Worthington, MN 56187
Phone (507) 372-3800

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

310 22nd Ave
Brookings, SD 57006
Phone (605) 696-2700

400 22nd Ave
Ste 1
Brookings, SD 57006
Phone (605) 697-9500

Interoperability endpoints

  • Direct secure messaging: katie.tetzlaff@avera.sdhealthlink.net

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1294 SD
Physician Assistant 363A00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

400 22ND Ave
Brookings, SD 57006-2450

Mailing address

400 22ND Ave
Brookings, SD 57006-2450

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 16, 2021.

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626393600000",
    "number": "1104371897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062450",
            "telephone_number": "605-697-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "KATIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1294",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.