John Lackey, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

M3873 Issued in ID

Practice address

500 S 11TH Ave
Pocatello, ID 83201-4835

Phone

(208) 232-3103

Fax

(208) 232-0756

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Obstetrics/GynecologyAlso: General Practice

Education

University of Missouri, Columbia School of Medicine, 1968

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shoshone Bannock Tribes, IncGroup PAC ID 5496804429, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028
• Bingham Memorial Hospital Hospital, Blackfoot, ID, CCN 131325

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Shoshone Bannock Tribes, Inc

  • Clinic/Center
  • Fort Hall, ID
  • NPI 1225414519

  TX

  Medicare reassignment Care Compare group
• Not Tsoo Gah Nee Indian Health

  • Health Service Clinic/Center
  • Fort Hall, ID
  • NPI 1558441139

  TX

  Medicare reassignment NPD

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

• BMH Inc

  • Critical Access Hospital
  • Blackfoot, ID
  • NPI 1982805271
  Care Compare affiliation
• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063456648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 CANYON DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832044840",
            "telephone_number": "208-234-1921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014835",
            "telephone_number": "208-232-3103",
            "fax_number": "208-232-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "M3873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002487500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle James Siemen, D.M.D., P.a.
• Laboratory Corporation of America
• Laboratory Corporation of America
• Idelia Labra
• Aspyn Lacey
• Lackson LLC
• Alexandria Lacroix
• Demetra Lally
• Jeanette Nicole Lamb, CNM
• Justus Flin Lambson, PA-C

• Specialist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.