NPIMap

Individual provider Active NPI

Mark H Weidner, MD

  • Nephrology Physician
  • Glens Falls, NY
National Provider Identifier
1972680288
Registry record updated Jun 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
210870 Issued in NY
Practice address
2 Broad Street PLZ
Broad Street Medical Group
Glens Falls, NY 12801-4363
Phone
(518) 926-1770
Fax
(518) 926-1799
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 210870 NY Primary

Addresses

Primary practice location

2 Broad Street PLZ
Broad Street Medical Group
Glens Falls, NY 12801-4363

Mailing address

PO Box 304
Glens Falls, NY 12801-0304
Phone (518) 926-1770

Other identifiers 3

IdentifierTypeStateIssuer
01609810MedicaidNY
RB8388OtherNYMEDICARE
0VN1263MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060404000093 VT Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Nephrology 1658389598 Reassigns benefits to 1 organization
I20080611000278 NY Practitioner - Internal MedicinePractitioner - Nephrology 1658389598 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rutland Hospital, Inc.Group PAC ID 7214846377, 186 clinicians
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

160 Allen St
Rutland, VT 05701-4560
Phone (802) 775-7111

211 Church St
Saratoga Springs, NY 12866-1003
Phone (518) 583-8421

Hospital & facility affiliations

  • Saratoga Hospital Hospital, Saratoga Springs, NY, CCN 330222
  • Rutland Regional Medical Center Hospital, Rutland, VT, CCN 470005
  • Albany Medical Center Hospital Hospital, Albany, NY, CCN 330013
  • Glens Falls Hospital Hospital, Glens Falls, NY, CCN 330191

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
210870NYMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Dec 11, 2017 Accepting new patients
Saratoga Regional Medical , P.C CurrentSince May 1, 2023 Accepting new patients
Rutland Hospital, Inc. CurrentSince Oct 1, 2020 Accepting new patients
Saratoga Hospital Current Accepting new patients
Saratoga Regional Medical , P.C Nephrology Current Accepting new patients
Saratoga Regional Medical , P.C CurrentSince May 1, 2023 Accepting new patients
Rutland Hospital, Inc. CurrentSince Oct 1, 2020 Accepting new patients
Saratoga Hospital Past Accepting new patients
Rutland Hospital, Inc. Past Accepting new patients

Locations

112 Charlton Rd
Charlton, NY 12019
Phone (518) 399-7723

2 Broad Street Plz
Glens Falls, NY 12801
Phone (518) 793-0519

59C Myrtle St
Saratoga Springs, NY 12866
Phone (518) 587-1919

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

15 Maple Dell
Ste 1
Saratoga Springs, NY 12866
Phone (518) 583-7400

160 Allen St
Rutland, VT 05701

Interoperability endpoints

  • Direct secure messaging: mweidner102443@albanymed.direct-ci.com

Organizations & group practices 9

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 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1972680288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128010304",
            "telephone_number": "518-926-1770",
            "fax_number": "518-926-1799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BROAD STREET PLZ",
            "address_2": "BROAD STREET MEDICAL GROUP",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128014363",
            "telephone_number": "518-926-1770",
            "fax_number": "518-926-1799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDNER",
        "first_name": "MARK",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "210870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01609810",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "RB8388",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN1263",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

Verify at the official NPI Registry.