NPIMap

Organization Active NPI

Lake Heart Specialists

Doing business as Drs. Jajeh & Koch SC

  • Cardiovascular Disease Physician
  • Gurnee, IL
National Provider Identifier
1629063391
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
LAKE HEART SPECIALISTS
Doing business as
Drs. Jajeh & Koch SC
Practice address
35 Tower CT
Suite F
Gurnee, IL 60031-5712
Phone
(847) 360-8440
Fax
(847) 360-8468
NPI assigned
Sep 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

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

Authorized official

Name
Dr. Fahd Jajeh, MDNPI 1558355255
Title
President
Phone
(847) 360-8440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

35 Tower CT
Suite F
Gurnee, IL 60031-5712

Mailing address

35 Tower CT
Suite F
Gurnee, IL 60031-5712
Phone (847) 360-8440

Other names 1

  • Drs. Jajeh & Koch SC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000052 IL Part B Supplier - Clinic/Group Practice 6305749490 Receives reassigned benefits from 8 practitioners
Practice locations: Gurnee, IL; Libertyville, IL

National Provider Directory

National Provider Directory

Locations

731 S Il Route 21
Ste 110
Gurnee, IL 60031
Phone (224) 206-8974

1870 W Winchester Rd
Ste 241
Libertyville, IL 60048
Phone (847) 360-2844

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1629063391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 TOWER CT",
            "address_2": "SUITE F",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315712",
            "telephone_number": "847-360-8440",
            "fax_number": "847-360-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 TOWER CT",
            "address_2": "SUITE F",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315712",
            "telephone_number": "847-360-8440",
            "fax_number": "847-360-8468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEART SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "JAJEH",
        "authorized_official_first_name": "FAHD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-360-8440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Jajeh & Koch SC",
            "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 Jul 16, 2010; 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.