Individual provider Active NPI

John Christopher Stackow, MD

  • Hospitalist Physician
  • Post Falls, ID
National Provider Identifier
1922095397
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
M-6239 Issued in ID
Practice address
1551 E Mullan Ave Ste 102
Post Falls, ID 83854-9005
Phone
(208) 262-2328
Fax
(208) 619-5057
NPI assigned
Sep 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X M-6239 ID
Hospitalist Physician 208M00000X M-6239 ID Primary

Addresses

Primary practice location

1551 E Mullan Ave Ste 102
Post Falls, ID 83854-9005

Mailing address

1593 E Polston Ave
Post Falls, ID 83854-5326
Phone (208) 262-2300

Other practice location 1

1593 E Polston Ave
Post Falls, ID 83854-5326
Phone (208) 262-2300

Other identifiers 2

IdentifierTypeStateIssuer
1922095397MedicaidID
1022315MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080918000468 ID Practitioner - General SurgeryPractitioner - Hospitalist 8325115348 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Hospitalist
Education
New York University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Idaho Day Surgery LLCGroup PAC ID 0840101218, 87 clinicians

Practice addresses (Care Compare)

1593 E Polston Ave
Post Falls, ID 83854-5326
Phone (208) 262-2300

Hospital & facility affiliations

  • Northwest Specialty Hospital Hospital, Post Falls, ID, CCN 130066
  • Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Idaho Day Surgery LLC CurrentSince Feb 1, 2021 Accepting new patients
Shellman Inc PA CurrentSince Dec 15, 2024 Accepting new patients
Radia Inc P S PastSince Apr 1, 2021 Accepting new patients

Locations

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

750 N Syringa St
Ste 190
Post Falls, ID 83854
Phone (208) 262-2328

1593 E Polston Ave
Post Falls, ID 83854
Phone (208) 262-2300

750 N Syringa St
Ste 103
Post Falls, ID 83854
Phone (208) 415-0151

750 N Syringa St
Ste 100
Post Falls, ID 83854
Phone (208) 262-2600

1551 E Mullan Ave
Ste 102
Post Falls, ID 83854
Phone (208) 262-2328

750 N Syringa St
Ste 205
Post Falls, ID 83854
Phone (208) 262-0945

Organizations & group practices 3

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 4

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1922095397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1593 E POLSTON AVE",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838545326",
            "telephone_number": "208-262-2300",
            "fax_number": "208-262-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 E MULLAN AVE STE 102",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838549005",
            "telephone_number": "208-262-2328",
            "fax_number": "208-619-5057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1593 E Polston Ave",
            "address_purpose": "LOCATION",
            "city": "Post Falls",
            "state": "ID",
            "postal_code": "838545326",
            "country_code": "US",
            "telephone_number": "208-262-2300",
            "fax_number": "208-262-2390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACKOW",
        "first_name": "JOHN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M-6239",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "ID",
            "license": "M-6239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922095397",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022315",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Post Falls, ID

Sources for this page

Verify at the official NPI Registry.