NPIMap

Organization Active NPI

Thomas and Thomas Medical LTD

Doing business as heart and vascular center of lake county

  • Specialist
  • Gurnee, IL
National Provider Identifier
1427090125
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036109155 Issued in IL
Legal business name
THOMAS AND THOMAS MEDICAL LTD
Doing business as
heart and vascular center of lake county
Practice address
222 S Greenleaf St Ste 109
Gurnee, IL 60031-5705
Phone
(847) 336-1600
Fax
(847) 336-2380
NPI assigned
Jun 10, 2006
Last updated
Sep 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Authorized official

Name
Sherlene May Giron Dasalla
Title
Credentialing/Billing Specialist
Phone
(847) 336-1600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036109155 IL Primary

Addresses

Primary practice location

222 S Greenleaf St Ste 109
Gurnee, IL 60031-5705

Mailing address

222 S Greenleaf St Ste 109
Gurnee, IL 60031-5705
Phone (847) 336-1600

Other identifiers 1

IdentifierTypeStateIssuer
CG4315OtherILMEDICAE ID TYPE UNSPECIFI

Other names 1

  • heart and vascular center of lake county Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050421000857 IL Part B Supplier - Clinic/Group Practice 0648218412 Receives reassigned benefits from 3 practitioners
Practice locations: Zion, IL; Waukegan, IL; Gurnee, IL; Libertyville, IL

National Provider Directory

National Provider Directory

Locations

1 S Greenleaf St
Ste I
Gurnee, IL 60031
Phone (847) 336-1600

3915 W Oglesby Ave
Gurnee, IL 60031
Phone (847) 336-1600

3915 W Oglesby Ave
#1
Gurnee, IL 60031
Phone (847) 336-1600

3915 W Oglesby Ave
Ste I
Gurnee, IL 60031

2501 Emmaus Ave
Zion, IL 60099
Phone (847) 872-4561

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758672000000",
    "number": "1427090125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST STE 109",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-336-1600",
            "fax_number": "847-336-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST STE 109",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-336-1600",
            "fax_number": "847-336-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS AND THOMAS MEDICAL LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A",
        "authorized_official_last_name": "DASALLA",
        "authorized_official_first_name": "SHERLENE MAY",
        "authorized_official_middle_name": "GIRON",
        "authorized_official_title_or_position": "CREDENTIALING/BILLING SPECIALIST",
        "authorized_official_telephone_number": "847-336-1600"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036109155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAE ID TYPE UNSPECIFI",
            "identifier": "CG4315",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2",
            "affiliation": "N",
            "address_1": "3915 Oglesby Ave Ste I",
            "city": "Gurnee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600313358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "heart and vascular center of lake county",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "heart and vascular center of lake county",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.