NPIMap

Individual provider Active NPI

Colleen Hogan Tetzlaff, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1144306689
Registry record updated Feb 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA053367 Issued in PA
Practice address
333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434
Phone
(215) 728-2500
NPI assigned
Oct 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA04371 TX
Physician Assistant 363A00000X MA053367 PA Primary

Addresses

Primary practice location

333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434

Mailing address

333 Cottman Ave
Enrollment Dept.
Philadelphia, PA 19111-2434
Phone (215) 214-1405

Other names 1

  • Ms. Colleen Hogan Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090304000463 PA Practitioner - Physician Assistant 6305899824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

333 Cottman Ave
Philadelphia, PA 19111-2434
Phone (844) 570-1767

3401 N Broad St
Philadelphia, PA 19140-5103

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
49.71
Promoting interoperability
100
Improvement activities
40
Cost
74.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA04371TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Jan 29, 2021 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Jan 29, 2021 Accepting new patients
Fox Chase Cancer Center Medical Group, Inc CurrentSince Sep 17, 2014 Accepting new patients
Health Services of Fox Chase Cancer Center Past Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
Health Services of Fox Chase Cancer Center Past Accepting new patients

Locations

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

Organizations & group practices 7

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234828800000",
    "number": "1144306689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "address_2": "ENROLLMENT DEPT.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-214-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "address_2": "FOX CHASE CANCER CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-728-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "COLLEEN",
        "middle_name": "HOGAN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2009-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04371",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA053367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "HOGAN",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.