BEACON MEDICAL GROUP, INC. (NPI# 1053361543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053361543 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Practice Address |
6913 N Main St Ste 300 Granger IN 46530 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746471500 |
| Practice Fax Number | 5746472567 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2018-06-27 |
| Authorized Official Name | JEFFREY COSTELLO (VP-CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | 01043104A | IN | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6913 N Main St Ste 200, Granger, IN 465308039 | 5746472567 | 5746472971 |
| 6901 N Main St Ste 102, Granger, IN 465308022 | 5746474500 | 5746476354 |
| 6913 N Main St, Granger, IN 465308039 | 5746471550 | 5742434306 |
| 1028 E Waterford St Ste A, Wakarusa, IN 465739305 | 5748622504 | 5748622505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487038360 | Beacon Medical Group, Inc. | Radiology | 233 Florence Ave, Granger, IN 46530-8048 | 2015-07-10 |
| 1124423546 | Beacon Medical Group, Inc. | Internal Medicine | 100 Navarre Pl Ste 4400, South Bend, IN 46601-1100 | 2014-10-28 |
| 1487061131 | Beacon Medical Group, Inc. | Internal Medicine | 2400 N Ventura Way, Lagrange, IN 46761-4101 | 2014-07-15 |
| 1437574530 | Beacon Medical Group, Inc. | Otolaryngology | 711 S Health Pkwy Ste 1, Medical Office Building #1, Three Rivers, MI 49093-8354 | 2014-02-26 |
| 1528362647 | Beacon Medical Group, Inc. | Internal Medicine | 500 Arcade Ave., Suite 400, Elkhart, IN 46514 | 2011-01-04 |
| 1699794057 | Beacon Medical Group, Inc. | Internal Medicine | 500 Arcade Ave Ste 300, Elkhart, IN 46514-2486 | 2006-07-18 |
| 1205852365 | Beacon Medical Group, Inc. | Family Medicine | 27082 W. Main Street, Edwardsburg, MI 49112-9334 | 2006-07-14 |
| 1861421141 | Beacon Medical Group, Inc. | Psychiatry & Neurology | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2006-06-30 |
| 1467408237 | Beacon Medical Group, Inc. | Pediatrics | 615 N Michigan St Fl 5, South Bend, IN 46601 | 2006-05-25 |
| 1275587149 | Beacon Medical Group, Inc. | Family Medicine | 813 S Michigan St, South Bend, IN 46601 | 2006-05-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BEACON MEDICAL GROUP, INC. | 4601 Glendale Court, Savage, MN 55378-2543 |
| Street Address |
6913 N MAIN ST STE 300 |
| City | GRANGER |
| State | IN |
| Zip Code | 46530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962401091 | Cynthia Lynn Pascual | Family Medicine | 6913 N Main St Ste 300, Granger, IN 46530-8039 | 2005-07-20 |
| 1891207320 | Barbara Ann Glassford | Nurse Practitioner | 6913 N Main St Ste 300, Granger, IN 46530-8039 | 2017-10-24 |
| 1336673037 | Johnny Lee Gerardot Jr. | Family Medicine | 6913 N Main St Ste 300, Granger, IN 46530-8039 | 2017-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821610783 | Michiana Weight Loss and Wellness Clinic LLC | Internal Medicine | 14304 Sr 23, Granger, IN 46530 | 2020-05-14 |
| 1609427921 | Stephen J Armet | Physical Therapist | 16733 Saratoga Ct, Granger, IN 46530 | 2019-09-27 |
| 1881177756 | Memorial Hospital of South Bend | General Acute Care Hospital | 3220 Beacon Parkway, Granger, IN 46530 | 2018-09-07 |
| 1922483635 | Kiley Ramer | Behavioral Analyst | 6910 N Main St Bldg 13c51, Granger, IN 46530 | 2015-07-23 |
| 1326439415 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 625 E University Dr., Granger, IN 46530 | 2015-02-10 |
| 1811302094 | Costco Wholesale Corporation | Pharmacy | 625 E. University Drive, Granger, IN 46530 | 2014-06-25 |
| 1255773255 | Tracy Joyce Abel | Behavioral Analyst | 12042 Covered Wagon Court, Granger, IN 46530 | 2013-07-19 |
| 1225376304 | George Youssef | Internal Medicine | 5610 Town Center Drive #14, Granger, IN 46530 | 2013-01-23 |
| 1033489596 | Rene Raul Arce Guarnaluse | Homeopath | Emilio Bayarri 50, Puzol, VALENCIA 46530 | 2011-12-30 |
| 1568747368 | Ranya Bouzou-kadi | Pharmacist | 13060 Adams, Granger, IN 46530 | 2011-10-13 |
| Find all providers in zip 46530 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952694549 | Benjamin Wilson | Family Medicine | 115 Sunnyside Ave Ste A, Granger, WA 98932 | 2011-05-16 |
| 1902137060 | Candace Corson | Family Medicine | 16641 Brick Rd, Granger, IN 46530-8518 | 2010-01-28 |
| 1376737387 | Shelley A. Morris | Family Medicine | 12340 Bittersweet Commons Blvd W, Granger, IN 46530-6959 | 2007-09-03 |
| 1083822993 | Michael Dennison Conroy | Family Medicine | 16205 Baywood Ln, Granger, IN 46530-7896 | 2007-05-21 |
| 1518180512 | Smita V Patel | Family Medicine | 922 East University Drive, Granger, IN 46530-4466 | 2007-04-10 |
| 1861418394 | Julie M Ortega-schmitt | Family Medicine | 15015 Sr 23, Unit 3, Granger, IN 46530 | 2006-07-15 |
| 1437149952 | Matthew E Christ | Family Medicine | 12563 State Road 23, Granger, IN 46530-9226 | 2005-10-26 |
| 1962401091 | Cynthia Lynn Pascual | Family Medicine | 6913 N Main St Ste 300, Granger, IN 46530-8039 | 2005-07-20 |
| 1487653408 | Mark P Schmeltz | Family Medicine | 12340 Bittersweet Commons Blvd. West, Granger, IN 45630-6959 | 2005-07-20 |
| 1437152394 | Lori L. Checkley | Family Medicine | 6913 N Main St, Granger, IN 46530-8039 | 2005-05-24 |
| Find all providers in GRANGER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.