Dr Mark Douglas Breithaupt, PHD in San Jose, CA - Medicare Psychologist Provider

Dr Mark Douglas Breithaupt, PHD is a medicare enrolled "Psychologist - Clinical" provider in San Jose, California. His current practice location is 1100 Lincoln Ave Ste 394, San Jose, California. You can reach out to his office (for appointments etc.) via phone at (408) 320-2747.

Dr Mark Douglas Breithaupt is licensed to practice in Hawaii (license number PSY 499) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053436337.

Contact Information

	Dr Mark Douglas Breithaupt, PHD
	1100 Lincoln Ave Ste 394, San Jose, CA 95125
	(408) 320-2747
	(408) 320-2747

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Mark Douglas Breithaupt
Gender	Male
Speciality	Psychologist - Clinical
Location	1100 Lincoln Ave Ste 394, San Jose, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1053436337
Provider Enumeration Date: 03/19/2007
Last Update Date: 09/09/2019

Medicare PECOS Information:

PECOS PAC ID: 2264455120
Enrollment ID: I20060106000439

Medical Identifiers

Medical identifiers for Dr Mark Douglas Breithaupt such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1053436337	NPI	-	NPPES
A 3812-3	Other	HI	HMSA
03451701	Medicaid	HI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	PSY 499 (Hawaii)	Secondary
103TA0400X	Psychologist - Addiction (substance Use Disorder)	(* (Not Available))	Secondary
106H00000X	Marriage & Family Therapist	PSY 499 (Hawaii)	Secondary
103TC0700X	Psychologist - Clinical	PSY 499 (Hawaii)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mark Douglas Breithaupt allows following entities to bill medicare on his behalf.

Entity Name	Community Clinic Of Maui, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1528042561 PECOS PAC ID: 2466365440 Enrollment ID: O20040219000740

Entity Name	Mark D Breithaupt Phd Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1902115082 PECOS PAC ID: 8123208618 Enrollment ID: O20110216000359

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mark Douglas Breithaupt is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Mark Douglas Breithaupt, PHD Po Box 8396, San Jose, CA 95155-8396 Ph: (408) 320-2747	Dr Mark Douglas Breithaupt, PHD 1100 Lincoln Ave Ste 394, San Jose, CA 95125 Ph: (408) 320-2747

Reviews and Comments

Psychologist in San Jose, CA

Dr. Rethel E. Gill, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1927 Otoole Way, San Jose, CA 95131 Phone: 707-861-8276
Marie Roman-clifton, PHD Psychologist Medicare: Accepting Medicare Assignments Practice Location: 751 S Bascom Ave, Psychology Services-pm&r, San Jose, CA 95128 Phone: 408-885-4445
Dr. Jennifer Gregg, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: Dept Of Psychology, One Washington Square, San Jose, CA 95192 Phone: 650-743-7230
Ms. Nicole Alvarez Bautista, BA Psychologist Medicare: Not Enrolled in Medicare Practice Location: 2400 Moorpark Ave, San Jose, CA 95128 Phone: 408-975-2730
Mr. Donald B Dufford, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3880 S Bascom Ave, Suite 212, San Jose, CA 95124 Phone: 408-559-9088 Fax: 408-377-7833
Dr. Sepideh Afrakhteh Katz, PH. D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3500 Zanker Road, San Jose, CA 95134 Phone: 408-451-6198
Dr. Kelly Sue Lynch, PHD Psychologist Medicare: Medicare Enrolled Practice Location: 2001 The Alameda, Momentum For Mental Health Service Team Adult Outpatie, San Jose, CA 95126 Phone: 408-261-7777 Fax: 408-259-2273

Dr Mark Douglas Breithaupt, PHD - Medicare Psychologist in San Jose, CA