Individual provider Active NPI

Mark A. Gruber, CRNA

  • Certified Registered Nurse Anesthetist
  • Morehead City, NC
National Provider Identifier
1205875911
Registry record updated Dec 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
157903 Issued in NC
Practice address
3500 Arendell St
Morehead City, NC 28557-2901
Phone
(252) 499-6000
Fax
(252) 808-6938
NPI assigned
Jun 6, 2006
Last updated
Dec 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN197129L PA
Certified Registered Nurse Anesthetist 367500000X 74148 WV
Certified Registered Nurse Anesthetist 367500000X 157903 NC Primary

Addresses

Primary practice location

3500 Arendell St
Morehead City, NC 28557-2901

Mailing address

404 Eastley CT Apt 2
Kingsport, TN 37660-6411
Phone (803) 479-2372

Other identifiers 3

IdentifierTypeStateIssuer
8053355MedicaidND
165554472OtherPATRICARE
8053355MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
11503TNMDInternal Medicine Physician
7925SCMDSpeech-Language Pathologist
157903NCMDCertified Registered Nurse Anesthetist
RN197129LPAMDCertified Registered Nurse Anesthetist
74148WVMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Blair County Anesthesia, P.C. Past Accepting new patients
Anesthesia Associates of York PA Inc Nurse Anesthetist, Certified Registered Past Accepting new patients
American Anesthesiology Associates of Virginia, Inc Past Accepting new patients
Colleton Medical Anesthesia, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Wvuh-East Services, Inc Past Accepting new patients
Lexington Anesthesia Associates, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients
Colleton Medical Hospitalists LLC Past Accepting new patients

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576886400000",
    "number": "1205875911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 EASTLEY CT APT 2",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376606411",
            "telephone_number": "803-479-2372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 ARENDELL ST",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285572901",
            "telephone_number": "252-499-6000",
            "fax_number": "252-808-6938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBER",
        "first_name": "MARK",
        "middle_name": "A.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2019-12-21",
        "certification_date": "2019-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN197129L",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "74148",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "157903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8053355",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "165554472",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8053355",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morehead City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.