Active NPI
John Christopher Stackow, MD
- Hospitalist Physician
- Post Falls, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- M-6239
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922095397 | Medicaid | ID | |
| 1022315 | Medicaid | WA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- New York University School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1593 E Polston Ave
Post Falls, ID 83854-5326
Phone (208) 262-2300
Hospital & facility affiliations
- Northwest Specialty Hospital
- Kootenai Health
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Idaho Day Surgery LLC | Current | Accepting new patients | |
| Shellman Inc PA | Current | Accepting new patients | |
| Radia Inc P S | Past | 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.
-
- General Acute Care Hospital
- Post Falls, ID
- NPI 1104824739
-
- Physical Therapist
- Coeur D Alene, ID
- NPI 1326050253
-
- Diagnostic Radiology Physician
- Lynnwood, WA
- NPI 1932196607
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Coeur D Alene, ID
- NPI 1992798409
-
- General Acute Care Hospital
- Post Falls, ID
- NPI 1104824739
-
- Sleep Medicine (Psychiatry & Neurology) Physician
- Post Falls, ID
- NPI 1649123589
Hospital
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.