NPIMap

Individual provider Active NPI

John David Stageberg, M.D.

  • Radiation Oncology Physician
  • Pueblo, CO
National Provider Identifier
1861457640
Registry record updated Jul 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
41213 Issued in CO
Practice address
1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone
(719) 557-5460
Fax
(719) 560-7217
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 41213 CO Primary

Addresses

Primary practice location

1008 Minnequa Ave
Pueblo, CO 81004-3733

Mailing address

1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone (719) 557-5460

Other identifiers 1

IdentifierTypeStateIssuer
55351760MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20101027001536 CO Practitioner - Radiation Oncology 1052480399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of North Dakota School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone (719) 776-8040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41213COMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado CurrentSince Nov 29, 2022 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Nov 29, 2022 Accepting new patients
Catholic Health Initiatives Colorado Current Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

2222 N Nevada Ave
Ste CC101
Colorado Springs, CO 80907
Phone (719) 570-7675

6031 E Woodmen Rd
Ste 150
Colorado Springs, CO 80923
Phone (719) 776-5281

1008 Minnequa Ave
Pueblo, CO 81004
Phone (719) 557-5656

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 4

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 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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374278400000",
    "number": "1861457640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-557-5460",
            "fax_number": "719-560-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-557-5460",
            "fax_number": "719-560-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAGEBERG",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2013-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CO",
            "license": "41213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55351760",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.