DR. DANIEL TIMOTHY TETZLAFF (PSYD, JD) – Clinical Psychologist, NPI 1053685487
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,216 CLINICAL PSYCHOLOGIST in MI
Provider Addresses for DR. DANIEL TIMOTHY TETZLAFF (PSYD, JD)
605 E 7TH AVE
SAULT SAINTE MARIE, MI 497833111
Phone: (906) 635-7270
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-05-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180526000027 | I | Clinical Psychologist | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90834 | Psychotherapy, 45 minutes | 55 | 15 | $0 |
| 90791 | Psychiatric diagnostic evaluation | 11 | 11 | $0 |
Insurance plans in this area (ZIP 49783)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IN | |
| Physician Assistant | MI | |
| Physician Assistant | MI | |
| D E R M A T O L O G Y | MI | |
| Pain Management | IL | |
| - | MI | |
| E N D O C R I N O L O G Y | MI | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MI | |
| Hospitalist, Internal Medicine | MI | |
| - | MI |
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