NPIMap

Individual provider Active NPI

Stacey Shannon Gugino, MD

  • Family Medicine Physician
  • Williamsville, NY
National Provider Identifier
1346438157
Registry record updated Feb 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
274288 Issued in NY
Practice address
1150 Youngs Rd
Williamsville, NY 14221-8053
Phone
(716) 636-7979
NPI assigned
Oct 5, 2007
Last updated
Feb 2, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2016

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 274288 NY Primary

Addresses

Primary practice location

1150 Youngs Rd
Williamsville, NY 14221-8053

Mailing address

1150 Youngs Rd
Williamsville, NY 14221-8053
Phone (716) 636-7979

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
I20140605001229 NY Practitioner - Family Practice 5799875845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Buffalo School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Buffalo Hearing and Speech Center, IncGroup PAC ID 4183818370, 43 clinicians
Highgate Medical Group PCGroup PAC ID 6901885565, 58 clinicians

Practice addresses (Care Compare)

50 E N St
Buffalo, NY 14203-1002
Phone (716) 885-8318

6255 Sheridan Dr
Williamsville, NY 14221-4825
Phone (716) 636-7979

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
274288NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Highgate Medical Group Family Medicine CurrentSince Jan 25, 2016 Accepting new patients
Highgate Medical Group Current Accepting new patients
Harris Hill Nursing Facility, LLC Past Accepting new patients
Brothers of Mercy Nursing Home Company Inc Past Accepting new patients
Garden Gate Health Care Facility LLC Past Accepting new patients

Locations

3950 E Robinson Rd
Ste 305
West Amherst, NY 14228

1150 Youngs Rd
Williamsville, NY 14221
Phone (716) 632-4696

6255 Sheridan Dr
Williamsville, NY 14221
Phone (716) 630-2582

6255 Sheridan Dr
Ste 200
Williamsville, NY 14221
Phone (716) 564-1111

Interoperability endpoints

  • Direct secure messaging: sgugino@highgatemedical.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brothers of Mercy Nursing and Rehabilitation CenterClarence, NY, CCN 335112 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Sep 1, 2022
Sep 1, 2022
Jul 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1346438157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 YOUNGS RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218053",
            "telephone_number": "716-636-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 YOUNGS RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218053",
            "telephone_number": "716-636-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUGINO",
        "first_name": "STACEY",
        "middle_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "274288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.