Individual provider Active NPI

Katherine Driver Tefft, PAC

  • Physician Assistant
  • New York, NY
National Provider Identifier
1205116076
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085004071 Issued in IL
Practice address
129 W 29TH St
2ND Floor
New York, NY 10001-5105
Phone
(415) 658-6791
Fax
(415) 252-7176
NPI assigned
Aug 24, 2011
Last updated
Mar 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA5322 MA
Physician Assistant 363A00000X 52415 CA
Physician Assistant 363A00000X 018509 NY
Physician Assistant 363A00000X 085004071 IL Primary

Addresses

Primary practice location

129 W 29TH St
2ND Floor
New York, NY 10001-5105

Mailing address

2800 N Sheridan Rd
Ste 101
Chicago, IL 60657-6156
Phone (773) 281-7835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111107000744 IL Practitioner - Physician Assistant 7618140641 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
One Medical Group IncGroup PAC ID 2567623739, 330 clinicians

Practice addresses (Care Compare)

4999 Old Orchard Shopping Ctr
Suite F12
Skokie, IL 60077
Phone (312) 219-2230

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52415CAMDPhysician Assistant
PA5322MAMDPhysician Assistant
018509NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
One Medical Group, Inc. CurrentSince Feb 18, 2026 Accepting new patients
One Medical Group, Inc CurrentSince Feb 18, 2026 Accepting new patients
Rush Oak Park Physicians Group Lake Street Past Accepting new patients

Locations

181 W Madison St
Ste 3825
Chicago, IL 60602
Phone (312) 999-5510

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1205116076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N SHERIDAN RD",
            "address_2": "STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576156",
            "telephone_number": "773-281-7835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W 29TH ST",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015105",
            "telephone_number": "415-658-6791",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEFFT",
        "first_name": "KATHERINE",
        "middle_name": "DRIVER",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-24",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA5322",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52415",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018509",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.