NPIMap

Individual provider Active NPI

Timothy Edwin Tetzlaff, MD

  • Family Medicine Physician
  • Burns, OR
National Provider Identifier
1154719656
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD204574 Issued in OR
Practice address
559 W Washington St
Burns, OR 97720-1441
Phone
(541) 573-2074
NPI assigned
Jan 6, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD204574 OR Primary

Addresses

Primary practice location

559 W Washington St
Burns, OR 97720-1441

Mailing address

559 W Washington St
Burns, OR 97720-1441
Phone (541) 573-2074

Other practice location 1

557 W Washington St
Burns, OR 97720-1441
Phone (541) 573-7281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20210714003249 OR Practitioner - Family Practice 2769817824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harney District HospitalGroup PAC ID 6800877424, 35 clinicians

Practice addresses (Care Compare)

557 W Washington St
Burns, OR 97720-1441
Phone (541) 573-7281

559 W Washington St
Burns, OR 97720-1441
Phone (541) 573-2074

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.71 of 100Reported as group
Quality
71.18
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Harney District Hospital CurrentSince Jul 7, 2021 Accepting new patients
Harney District Hospital CurrentSince Jul 7, 2021 Accepting new patients
Harney District Hospital Current Accepting new patients
Harney District Hospital Past Accepting new patients
Harney District Hospital Family Medicine Past Accepting new patients

Locations

557 W Washington St
Burns, OR 97720
Phone (541) 573-3682

559 W Washington St
Burns, OR 97720
Phone (541) 573-2074

271 N Egan Ave
Burns, OR 97720
Phone (541) 573-2301

Interoperability endpoints

  • Direct secure messaging: ttetzlaff135928@secure.stcharleshealthcare.org

Organizations & group practices 5

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1154719656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 W WASHINGTON ST",
            "city": "BURNS",
            "state": "OR",
            "postal_code": "977201441",
            "telephone_number": "541-573-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 W WASHINGTON ST",
            "city": "BURNS",
            "state": "OR",
            "postal_code": "977201441",
            "telephone_number": "541-573-2074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "557 W Washington St",
            "address_purpose": "LOCATION",
            "city": "Burns",
            "state": "OR",
            "postal_code": "977201441",
            "country_code": "US",
            "telephone_number": "541-573-7281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "TIMOTHY",
        "middle_name": "EDWIN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-06",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD204574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burns, OR

Sources for this page

Verify at the official NPI Registry.