NPIMap

Individual provider Active NPI

Thomas J Vasdekas, M.D.

  • Surgery Physician
  • Homer Glen, IL
National Provider Identifier
1275630253
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036068616 Issued in IL
Practice address
12701 W 143Rd St
Homer Glen, IL 60491-7715
Phone
(815) 300-7764
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036068616 IL Primary

Addresses

Primary practice location

12701 W 143Rd St
Homer Glen, IL 60491-7715

Mailing address

12701 W 143Rd St
Homer Glen, IL 60491-7715
Phone (815) 300-7764

Other practice location 1

17047 La Grange Rd
Orland Park, IL 60487-7227
Phone (815) 300-7764

Other identifiers 3

IdentifierTypeStateIssuer
020016372OtherILPALMETTO RR MEDICARE
31604034OtherILBLUE CROSS BLUE SHIELD
036068616MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100326000988 IL Practitioner - General Surgery 5799811923 Reassigns benefits to 1 organization
Practice locations: Joliet, IL; Homer Glen, IL; Orland Park, IL; New Lenox, IL

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Suburban Medical Group, PLLCGroup PAC ID 5294155818, 31 clinicians

Practice addresses (Care Compare)

1200 Maple Rd
Joliet, IL 60432-1439
Phone (815) 740-7087

15300 W Ave
Suite 202
Orland Park, IL 60462-4683
Phone (708) 364-0441

1900 Silver Cross Blvd
New Lenox, IL 60451-9509
Phone (815) 300-1100

222 Colorado Ave
Frankfort, IL 60423-1334
Phone (815) 300-7764

7425 Janes Ave
Woodridge, IL 60517-2356
Phone (815) 300-7764

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)29
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Health Service Systems, Inc Surgery Past Accepting new patients
Thomas J Vasdekas, M.D. Surgery PastSince Jan 1, 1990 Accepting new patients
Primary Health Associates PC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JGEBDA

Organizations & group practices 4

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 6

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1275630253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "815-300-7764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "815-300-7764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17047 La Grange Rd",
            "address_purpose": "LOCATION",
            "city": "Orland Park",
            "state": "IL",
            "postal_code": "604877227",
            "country_code": "US",
            "telephone_number": "815-300-7764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASDEKAS",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036068616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO RR MEDICARE",
            "identifier": "020016372",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "31604034",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036068616",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer Glen, IL

Sources for this page

Verify at the official NPI Registry.