MEDICARE: DR. JOHN GUS STAGIAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	80381	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110088781	OTHER	MA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080381	OTHER	MA	TUFTS
2	64553	OTHER	MA	HARVARD PILGLRIM
4	S029063	OTHER	MA	CHAMPUS
5	33988	OTHER	MA	BMC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	J14840	OTHER	MA	BCBS
8	452850	OTHER	MA	AETNA US HEALTHCARE
9	983813	OTHER	MA	NETWORK HEALTH
10	010080381MA01	OTHER	CT	ANTHEM BCBS
11	21577	OTHER	MA	FALLON COM HEALTH PLAN

General Provider Information

NPI Number	:	1023012424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GUS STAGIAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:
City	:	STURBRIDGE
State	:	MA
Zip	:	01566-0250
Country	:	US
Telephone Number	:	508-765-1600
Fax Number	:	508-765-0253

Provider Business Practice Location Address
First Line	:	428 HAMILTON ST
Second Line	:
City	:	SOUTHBRIDGE
State	:	MA
Zip	:	01550-1859
Country	:	US
Telephone Number	:	508-765-1600
Fax Number	:	508-765-0253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/21/2012

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