JOHN LACKEY MD
NPI 1063456648
Specialist in Pocatello, ID
About John Lackey Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JOHN LACKEY MD (NPI 1063456648) is an individual specialist in Pocatello, Idaho, licensed in Idaho (M3873) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Portneuf Medical Center, and is a graduate of University Of Missouri, Columbia School Of Medicine (1968).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
John Lackey Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show John Lackey reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Fort Hall, ID 83203
- Reassigned Medicare billing, Texas enrollment
- 7 clinicians in this Medicare group
Fort Hall, ID 83203
- Reassigned Medicare billing, Texas enrollment
- 8 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Portneuf Medical Center
Acute Care Hospitals · Pocatello, IDOther Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
POCATELLO, ID 83201
POCATELLO, ID 83201
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is John Lackey's NPI number?
The NPI number for John Lackey is 1063456648. It was assigned to this individual provider in the NPPES registry on June 15, 2006.
Where is John Lackey located?
John Lackey practices at 500 S 11th Ave, Pocatello, ID 83201. The listed phone number is (208) 232-3103.
What is John Lackey's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is John Lackey enrolled in Medicare?
Yes. John Lackey is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for John Lackey's services?
According to the CMS Revalidation Reassignment List (October 2026 release), John Lackey reassigns Medicare benefits to 2 organizations: Not Tsoo Gah Nee Indian Health (Fort Hall, ID) and Shoshone Bannock Tribes, Inc (Fort Hall, ID). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for John Lackey's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is John Lackey affiliated with any hospitals?
According to CMS data, John Lackey is affiliated with Portneuf Medical Center.
When was this NPI record last updated?
The NPPES record for John Lackey was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# John Lackey, MD · NPI 1063456648
Specialist provider in Pocatello, Idaho. Individual provider, active in the CMS NPPES registry since June 15, 2006.
## Identity
- **NPI:** 1063456648 (Entity type: Individual)
- **Enumerated:** June 15, 2006
- **Primary specialty:** Specialist · taxonomy 174400000X
- **State license:** M3873 (Idaho)
- **Sole proprietor:** No
## Practice location
- **Address:** 500 S 11TH AVE, Pocatello, ID 83201-4835
- **Phone:** (208) 232-3103 · **Fax:** (208) 232-0756
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Not Tsoo Gah Nee Indian Health (NPI 1558441139, Fort Hall, ID); Shoshone Bannock Tribes, Inc (NPI 1801949763, Fort Hall, ID) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Missouri, Columbia School Of Medicine, class of 1968
## Record status
- **NPPES last updated:** July 8, 2007
- **Other identifiers:** Medicare ID-Type Unspecified 1112742 (ID); Medicare UPIN C36869 (ID); Medicaid 002487500 (ID)
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Source: [NPI Profile](https://npiprofile.com/npi/1063456648) · Data from the CMS NPPES public registry.