Kena D Lackman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-14465 Issued in ID

Practice address

725 Fair St
Buhl, ID 83316-6442

Phone

(208) 543-8271

Fax

(208) 543-8272

NPI assigned

Apr 28, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT, 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

Family Practice

Education

University of Washington School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health Services CorporationGroup PAC ID 7012815038, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kena.lackman.p1@direct.fhsid.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Burley, ID
  • NPI 1033165550

  Family Medicine, ID

  Medicare reassignment Care Compare group NPD
• St Lukes Community Hospital

  • Critical Access Hospital
  • Ronan, MT
  • NPI 1336213446

  MT

  Medicare reassignment NPD
• St. Lukes Community Hospital

  • Rural Health Clinic/Center
  • St. Ignatius, MT
  • NPI 1306911169

  Family Medicine, MT

  Medicare reassignment NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Rupert, ID
  • NPI 1093761694

  Family Medicine

  NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1235279217

  Family Medicine

  NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Fairfield, ID
  • NPI 1316984529

  Family Medicine

  NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Kimberly, ID
  • NPI 1538405410
  NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Kimberly, ID
  • NPI 1659946861
  NPD
• St Lukes Community Hospital

  • Certified Registered Nurse Anesthetist
  • Ronan, MT
  • NPI 1518663608
  NPD
• St Lukes Community Hospital

  • Rural Health Clinic/Center
  • Polson, MT
  • NPI 1548612096
  NPD
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Buhl, ID
  • NPI 1003862525

  Family Medicine

  NPD (past)
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Jerome, ID
  • NPI 1073188728

  Family Medicine

  NPD (past)

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

• St. Luke'S Magic Valley Regional Medical Center, LTD.

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1427583285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016856",
            "telephone_number": "208-734-3312",
            "fax_number": "208-734-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 FAIR ST",
            "city": "BUHL",
            "state": "ID",
            "postal_code": "833166442",
            "telephone_number": "208-543-8271",
            "fax_number": "208-543-8272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Rufus Ln",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598608903",
            "country_code": "US",
            "telephone_number": "406-883-2555",
            "fax_number": "406-883-2559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACKMAN",
        "first_name": "KENA",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-28",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-1634",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-14465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Kruse Imani, FNP-C
• Loriann Jones, C.N.M., L.M.
• K2Red LLC
• Spencer Kelsey, LCSW
• Clayton Kline
• Natalie Starr Livingston
• Jordan Marie Mitchell, NP-C
• Isaac B Moffett
• Gloria E Morse, PT
• Kari Anne Nebeker, RN

• Family Medicine Physician in Buhl, ID
• Providers in Buhl, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; 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.