Thomas Arthur Breitenbucher, PH.D., L.P.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP2794 Issued in MN

Practice address

6120 Earle Brown Dr
Suite 520
Brooklyn Center, MN 55430-2123

Phone

(763) 531-0566

Fax

(763) 531-0602

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Clinical Psychologist

Education

Other, 1994

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

North Therapy and Wellness PAGroup PAC ID 3870545668, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• North Therapy and Wellness PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Champlin, MN
  • NPI 1265462212
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1699846154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 EARLE BROWN DR",
            "address_2": "SUITE 520",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302123",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 EARLE BROWN DR",
            "address_2": "SUITE 520",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302123",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREITENBUCHER",
        "first_name": "THOMAS",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "PH.D., L.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "LP2794",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP2794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "104654",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "54R37BR",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433853700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "61-16175",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jalaya Bouye
• Jennifer Sue Boyd, MA, LMFT
• Brady Alexander Brabec
• Trae C Bracy
• Lazaria Kanese Bradford
• Phillip Joseph Breker, PHARMD
• Ross Allen Breneman
• Daniel S. Brewer Jr.
• Bridge Health Care Services LLC
• Bridging Together LLC Agency

• Clinical Psychologist in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.