NPIMap

Individual provider Active NPI

John David Anthony Lakatua, MD

  • Nephrology Physician
  • Missoula, MT
National Provider Identifier
1023063070
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
8432 Issued in MT
Practice address
500 West Broadway
Missoula, MT 59802-4008
Phone
(406) 721-5600
Fax
(406) 721-3907
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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 8432 MT Primary

Addresses

Primary practice location

500 West Broadway
Missoula, MT 59802-4008

Mailing address

PO Box 7609
Missoula, MT 59807-7609
Phone (406) 721-5600

Other practice location 1

435 S Crystal St Ste 240
Butte, MT 59701-1523
Phone (406) 496-3602

Other practice location 2

6 13th Ave E
Polson, MT 59860-5315
Phone (406) 883-5680

Other identifiers 1

IdentifierTypeStateIssuer
0107763MedicaidMT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jlakatua135187@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20100128000071 MT Practitioner - Nephrology 4789726878 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Minnesota Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services Mt 358 clinicians

Practice addresses (Care Compare)

400 S Clark St
Butte, MT 59701-2328

500 W Broadway St
Missoula, MT 59802-4003

500 W Broadway St
Missoula, MT 59802-4008

500 W Broadway St
Missoula, MT 59802-4096

500 W Broadway St 3Rd FL
Missoula, MT 59802-4096

5549 Old US Hwy 93
Florence, MT 59833-6545
Phone (406) 276-4923

Hospital & facility affiliations

  • FMC Missoula Dialysis facility, Missoula, MT, CCN 272507
  • FMC Butte Dialysis facility, Butte, MT, CCN 272508
  • Fresenius Medical Care Polson Dialysis facility, Polson, MT, CCN 272511
  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Community Hospital of Anaconda Hospital, Anaconda, MT, CCN 271335
  • St James Hospital Hospital, Butte, MT, CCN 270017
  • Barrett Hospital & Healthcare Hospital, Dillon, MT, CCN 271318
  • Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8432MTMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Credena Health LLC CurrentSince Jun 1, 2023 Accepting new patients
Western Montana Clinic PC Current Accepting new patients
Providence St Joseph Medical Center CurrentSince Jun 1, 2023 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 2, 2010 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 2, 2010 Accepting new patients
Western Montana Clinic PC Current Accepting new patients

Locations

435 S Crystal St
Ste 240
Butte, MT 59701
Phone (406) 496-3602

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

Organizations & group practices 10

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1023063070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7609",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598077609",
            "telephone_number": "406-721-5600",
            "fax_number": "406-721-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WEST BROADWAY",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-721-5600",
            "fax_number": "406-721-3907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 S Crystal St Ste 240",
            "address_purpose": "LOCATION",
            "city": "Butte",
            "state": "MT",
            "postal_code": "597011523",
            "country_code": "US",
            "telephone_number": "406-496-3602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6 13th Ave E",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598605315",
            "country_code": "US",
            "telephone_number": "406-883-5680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKATUA",
        "first_name": "JOHN",
        "middle_name": "DAVID ANTHONY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MT",
            "license": "8432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0107763",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlakatua135187@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 West Broadway",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.