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JOHN LACKEY MD
NPI 1063456648
Specialist in Pocatello, ID

Active since June 15, 2006PECOS EnrolledAccepts Medicare Assignment
500 S 11TH AVE, POCATELLO, ID 83201(208) 232-3103(208) 232-0756 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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

NPI1063456648
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameJOHN LACKEYCredential: MD
Location Address500 S 11TH AVEPocatello, ID 83201-4835
Mailing Address700 Canyon DrPocatello, ID 83204-4840 · (208) 234-1921
Phone(208) 232-3103
Fax(208) 232-0756
Sole ProprietorNo
Medical School CMSUniversity Of Missouri, Columbia School Of MedicineGraduated 1968
Enumeration DateJune 15, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1063456648 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in ID · M3873
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

500 S 11TH AVE, Pocatello, ID 83201
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Other Identifiers 3

Medicare ID-Type Unspecified1112742ID
Medicare UPINC36869ID
Medicaid002487500ID

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID6103958988
PECOS Enrollment IDI20100714000251
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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, ID
4/5 CMS rating
OwnershipProprietary
CMS Certification Number130028
Location777 Hospital WayPocatello, ID 83201 · Bannock County
Emergency services Birthing friendly

Other 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 CHILDREN'S CLINIC
Durable Medical Equipment & Medical Supplies
500 S 11TH AVE, STE 204
POCATELLO, ID 83201
Bannock County (208) 232-1443
JUNIPER SPRINGS INTERNAL MEDICINE
Internal Medicine
500 S 11TH AVE, SUITE 203
POCATELLO, ID 83201
Bannock County (208) 236-1600
JOHN L. CHRISTENSEN PHD
Psychologist (Clinical)
500 S 11TH AVE, SUITE 302
POCATELLO, ID 83201
Bannock County (208) 233-0150
JAMES MATTHEW CAMPBELL PA-C
Physician Assistant (Medical)
500 S 11TH AVE
POCATELLO, ID 83201
Bannock County (208) 232-6214
BARBARA ROBERTS NP
Nurse Practitioner (Women's Health)
500 S 11TH AVE, SUITE 4G
POCATELLO, ID 83201
Bannock County (208) 233-2161
LINDA L. BABBITT M.D.
Internal Medicine
500 S 11TH AVE, SUITE 203
POCATELLO, ID 83201
Bannock County (208) 232-5902
MRS. JENNA NICOLE THOMPSON LCSW
Social Worker (Clinical)
500 S 11TH AVE, SUITE 303
POCATELLO, ID 83201
Bannock County (208) 239-3815
JOHN L CHRISTENSEN PHD PC
Rehabilitation Counselor
500 S 11TH AVE, SUITE 302
POCATELLO, ID 83201
Bannock County (208) 233-0150

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.

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 with the weekly NPPES data releases published by CMS.