Active NPI
Mark A. Gruber, CRNA
- Certified Registered Nurse Anesthetist
- Morehead City, NC
National Provider Identifier
1205875911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 157903
- 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, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8053355 | Medicaid | ND | |
| 165554472 | Other | PA | TRICARE |
| 8053355 | Medicaid | NC |
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.
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11503 | TN | MD | Internal Medicine Physician |
| 7925 | SC | MD | Speech-Language Pathologist |
| 157903 | NC | MD | Certified Registered Nurse Anesthetist |
| RN197129L | PA | MD | Certified Registered Nurse Anesthetist |
| 74148 | WV | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New 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.
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- Anesthesiology Physician
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Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
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- NPI 1003864612
-
- Certified Registered Nurse Anesthetist
- Walterboro, SC
- NPI 1659316958
Nurse Anesthetist, Certified Registered
-
- Hospitalist Physician
- Walterboro, SC
- NPI 1942245246
-
- Certified Registered Nurse Anesthetist
- Altoona, PA
- NPI 1932144029
Nurse Anesthetist, Certified Registered
-
dba Martinsburg Anesthesia
- Anesthesiology Physician
- Martinsburg, WV
- NPI 1659563104
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.