NPIMap

Individual provider Active NPI

Mary Kyle Dyer-Martin, DO

  • Family Medicine Physician
  • Rensselaer, NY
National Provider Identifier
1659332575
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
212822 Issued in NY
Practice address
2 Empire Dr
Suite 100
Rensselaer, NY 12144-5730
Phone
(518) 286-4899
Fax
(518) 286-4859
NPI assigned
Mar 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 212822 NY Primary

Addresses

Primary practice location

2 Empire Dr
Suite 100
Rensselaer, NY 12144-5730

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
02085243MedicaidNY

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040607000594 NY Practitioner - Family Practice 7719969393 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
212822NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Family Medicine CurrentSince Jan 1, 2019 Accepting new patients
New York Family Medicine Associates, P.C. Family Medicine Past Accepting new patients

Locations

713 Troy Schenectady Rd
Ste 304
Latham, NY 12110
Phone (518) 373-4448

2 Empire Dr
Ste 202
Rensselaer, NY 12144
Phone (518) 286-4990

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

147 Hoosick St
Troy, NY 12180
Phone (518) 268-5749

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

Interoperability endpoints

  • Direct secure messaging: mdyermartin793794@direct.trinity-health.org

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.

Hospital & facility affiliations 6

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": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1659332575",
    "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": "2 EMPIRE DR",
            "address_2": "SUITE 100",
            "city": "RENSSELAER",
            "state": "NY",
            "postal_code": "121445730",
            "telephone_number": "518-286-4899",
            "fax_number": "518-286-4859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYER-MARTIN",
        "first_name": "MARY",
        "middle_name": "KYLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-30",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "212822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02085243",
            "state": "NY"
        }
    ],
    "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": "2 Empire Dr",
            "address_2": "Suite 100",
            "city": "Rensselaer",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121445730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rensselaer, NY

Sources for this page

Verify at the official NPI Registry.