Individual provider Active NPI

Mark Heyman, PH.D.

  • Clinical Psychologist
  • Solana Beach, CA
National Provider Identifier
1063783405
Registry record updated Jan 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
24174 Issued in CA
Practice address
767 Academy Dr
Solana Beach, CA 92075-2031
Phone
(858) 461-9295
Fax
(858) 793-4406
NPI assigned
Jan 17, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 24174 CA Primary

Addresses

Primary practice location

767 Academy Dr
Solana Beach, CA 92075-2031

Mailing address

767 Academy Dr
Solana Beach, CA 92075-2031
Phone (858) 461-9295

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141110001302 CA Practitioner - Clinical Psychologist 5092976241 Reassigns benefits to 1 organization
Practice locations: Solana Beach, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
George Washington University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5755 Oberlin Dr
Suite 301
San Diego, CA 92121-4717
Phone (858) 461-9295

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Heyman Psychologist Inc CurrentSince Apr 20, 2021 Accepting new patients
Center for Diabetes and Mental Health Clinical CurrentSince Nov 1, 2012 Accepting new patients

Locations

5755 Oberlin Dr
Ste 301
San Diego, CA 92121
Phone (435) 512-9912

767 Academy Dr
Solana Beach, CA 92075
Phone (858) 461-9295

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356998400000",
    "number": "1063783405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 ACADEMY DR",
            "city": "SOLANA BEACH",
            "state": "CA",
            "postal_code": "920752031",
            "telephone_number": "858-461-9295",
            "fax_number": "858-793-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 ACADEMY DR",
            "city": "SOLANA BEACH",
            "state": "CA",
            "postal_code": "920752031",
            "telephone_number": "858-461-9295",
            "fax_number": "858-793-4406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEYMAN",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-17",
        "last_updated": "2013-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "24174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Solana Beach, CA

Sources for this page

Verify at the official NPI Registry.