Individual provider Active NPI

Mark Thomas Grunert, PA-C

  • Physician Assistant
  • Albany, NY
National Provider Identifier
1639702772
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
024873 Issued in NY
Practice address
319 S Manning Blvd
Albany, NY 12208-1742
Phone
(518) 438-1019
NPI assigned
Feb 18, 2020
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 024873 NY Primary

Addresses

Primary practice location

319 S Manning Blvd
Albany, NY 12208-1742

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

4 Executive Park Dr Ste 2
Albany, NY 12203-3717
Phone (518) 489-7494

Other practice location 2

2 Empire Dr Ste 100
Rensselaer, NY 12144-5730
Phone (518) 286-4899

Other practice location 3

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-8600

Other practice location 4

1205 Troy Schenectady Rd Ste 101
Latham, NY 12110-1074
Phone (518) 348-3176

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200330002119 NY Practitioner - Physician Assistant 9931538717 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Tufts University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany Medical CollegeGroup PAC ID 1759293111, 1,054 clinicians

Practice addresses (Care Compare)

43 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-3277

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-5633

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Physician Assistant CurrentSince Oct 31, 2021 Accepting new patients
Albany Medical College CurrentSince Sep 29, 2025 Accepting new patients
St. Peter's Hospital of the City of Albany Physician Assistant CurrentSince Mar 1, 2023 Accepting new patients
Albany Medical College CurrentSince Sep 29, 2025 Accepting new patients
St. Peter's Hospital of the City of Albany Physician Assistant CurrentSince Mar 1, 2023 Accepting new patients
Wellnow Urgent Care, PC CurrentSince Jan 9, 2023 Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. Physician Assistant CurrentSince Mar 30, 2020 Accepting new patients
Albany Medical College Physician Assistant Past Accepting new patients

Locations

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

4 Executive Park Dr
Ste 2
Albany, NY 12203
Phone (518) 435-1231

43 New Scotland Ave
#139
Albany, NY 12208
Phone (518) 262-3131

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

446 Fairview Ave
Ste 200
Hudson, NY 12534
Phone (518) 267-3496

71 Prospect Ave
Hudson, NY 12534
Phone (518) 262-3773

117 Marys Ave
Ste 202
Kingston, NY 12401
Phone (845) 338-1717

7375 Oswego Rd
#1
Liverpool, NY 13090
Phone (315) 291-0064

2 Empire Dr
Ste 100
Rensselaer, NY 12144
Phone (518) 286-4899

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

1301 River St
Ste 204
Valatie, NY 12184
Phone (518) 392-8600

Interoperability endpoints

  • Direct secure messaging: ms_mgrunert@landmarkhealth-direct.org
  • Direct secure messaging: payer.credentialing@sphp.com

Organizations & group practices 8

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1639702772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634",
            "fax_number": "518-649-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 S MANNING BLVD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122081742",
            "telephone_number": "518-438-1019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Executive Park Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122033717",
            "country_code": "US",
            "telephone_number": "518-489-7494",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Empire Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Rensselaer",
            "state": "NY",
            "postal_code": "121445730",
            "country_code": "US",
            "telephone_number": "518-286-4899",
            "fax_number": "518-286-4859",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 S Manning Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122081707",
            "country_code": "US",
            "telephone_number": "518-525-8600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1205 Troy Schenectady Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Latham",
            "state": "NY",
            "postal_code": "121101074",
            "country_code": "US",
            "telephone_number": "518-348-3176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRUNERT",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-18",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "319 S Manning Blvd",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.