DR. MARK DOUGLAS BREITHAUPT (PH.D.) – Clinical Psychologist, NPI 1053436337
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,434 CLINICAL PSYCHOLOGIST in CA
Provider Addresses for DR. MARK DOUGLAS BREITHAUPT (PH.D.)
PO BOX 8396
SAN JOSE, CA 951558396
Phone: (408) 320-2747
Fax: (408) 320-2747
Type: Mailing
1100 LINCOLN AVE STE 394
SAN JOSE, CA 95125
Phone: (408) 320-2747
Fax: (408) 320-2747
Type: Location
PO BOX 2632
WAILUKU, HI 967937632
Phone: (808) 205-8403
Type: Mailing
2200 MAIN ST STE 510
WAILUKU, HI 967931624
Phone: (808) 205-8403
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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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: 2006-01-06
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 |
|---|---|---|---|---|
| I20060106000439 | I | Clinical Psychologist | HI | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 95155)
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