Mark Douglas Breithaupt, PH.D.
Individual provider Active NPI Clinical Psychologist · Wailuku, HI
NPI 1053436337 · NPPES record last updated May 19, 2025
Key facts
- NPI
- 1053436337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY 499 (HI)
- Practice address
- 2200 Main St Ste 510
Wailuku, HI 96793-1624 - Phone
- (808) 205-8403
- NPI assigned
- Mar 19, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2200 Main St
Suite 510
Wailuku, HI 96793-1624
Phone (808) 205-8403
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060106000439 | HI | Practitioner - Clinical Psychologist | 2264455120 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 499 | HI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark D Breithaupt PHD LLC | Clinical | Current |
Accepting new patients |
Locations
2200 Main St
Ste 510
Wailuku, HI 96793
Phone (808) 205-8403
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 499 | HI | |
| Marriage & Family Therapist | 106H00000X | PSY 499 | HI | |
| Clinical Psychologist | 103TC0700X | PSY 499 | HI | Yes |
Addresses
Primary practice location
2200 Main St Ste 510
Wailuku, HI 96793-1624
Mailing address
PO Box 2632
Wailuku, HI 96793-7632
Phone (808) 205-8403
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03451701 | Medicaid | HI | |
| A 3812-3 | Other | HI | HMSA |
Other providers in Wailuku, HI
- Annette Boulgourjian
- Sue Bourgeoishunt
- Sally M Bowles
- Daniel Brandes
- Kim Kimi Breitbach
- Malte Breitlow
- Michael Ross Brewer
- Brian I. Watanabe, M.D., Inc.
- Alexandria Emilie Brito
- Ellen Marie Brown
All providers in Wailuku, HI · Clinical Psychologist in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.