BEACON MEDICAL GROUP, INC. (NPI# 1124079330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124079330 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP IRELAND ROAD |
| Practice Address |
1815 E Ireland Rd South Bend IN 46614-2845 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746471700 |
| Practice Fax Number | 5742913351 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2016-08-29 |
| 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 |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01043622A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100224050B | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Ireland Road | Doing Business As Name - Organization |
| 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 |
1815 E IRELAND RD |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46614-2845 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396733101 | Douglas Mayer David | Family Medicine | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2005-10-06 |
| 1699322446 | Evelin Keultjes | Nurse Practitioner | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2019-08-26 |
| 1548766249 | Dena Nichole Garnett | Physical Therapist | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2018-04-02 |
| 1467909697 | Sarah Anne Martin | Physician Assistant | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2016-09-06 |
| 1245685510 | Kristin Jamison | Nurse Practitioner | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2016-04-25 |
| 1245626225 | Kathleen Kelley | Dermatology | 1815 E Ireland Rd, South Bend, IN 46614 | 2015-04-07 |
| 1881085967 | Shanti T Dalson | Physical Therapist | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2015-02-11 |
| 1144660838 | Amanda Leanne Springer | Family Medicine | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2013-06-27 |
| 1225321722 | Luiz C Pantalena Filho | Dermatology | 1815 E Ireland Rd, South Bend, IN 46614 | 2011-05-17 |
| 1437388220 | Jill M. Maddox | Nurse Practitioner | 1815 E Ireland Rd, South Bend, IN 46614-2845 | 2009-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417574013 | Hellen Gathesha | Nurse Practitioner | 2123 W Irvington Dr, South Bend, IN 46614 | 2020-06-30 |
| 1033759394 | Diane Galvas | Pharmacist | 1217 E. Ireland Rd., South Bend, IN 46614 | 2020-01-14 |
| 1730668690 | Julenne Henriquez-gil | Physical Therapist | 202 W Ireland Rd Ste 101a, South Bend, IN 46614 | 2018-08-11 |
| 1467747014 | Deidre A Coffey | Nurse Practitioner | 1025 Widener Ln, South Bend, IN 46614 | 2011-06-12 |
| 1588727655 | Wal-mart Stores East, Lp | Technician/Technologist | 700 W. Ireland Rd., South Bend, IN 46614 | 2006-12-19 |
| 1437262847 | Lori F Risser | Dentist | 734 E Ireland Rd, South Bend, IN 46614 | 2006-08-17 |
| 1912388018 | Laura Ellen Albright | Family Medicine | 2102 E Inwood Rd, South Bend, IN 46614 | 2015-06-15 |
| 1073869806 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 1950 Ridgedale Rd, South Bend, IN 46614 | 2012-07-30 |
| 1326300666 | Kristine Marie Jones | Optometrist | 700 W Ireland Rd, South Bend, IN 46614 | 2012-06-12 |
| 1760766968 | John Thomas Miller | Pharmacist | 1010 E Ireland Rd, South Bend, IN 46614 | 2011-10-06 |
| Find all providers in zip 46614 | ||||
| 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 |
|---|---|---|---|---|
| 1285998146 | Thomas Larsen | Family Medicine | 4440 Portage Ave, South Bend, IN 46628-9570 | 2012-06-26 |
| 1316180318 | Paul Angelo Carl Macri | Family Medicine | 2012 Cedar St, South Bend, IN 46617-2542 | 2009-04-07 |
| 1285818591 | Jaroslaw Kuna | Family Medicine | 320 S Saint Joseph St Ste 300, South Bend, IN 46601-2308 | 2007-12-21 |
| 1013117472 | Ronald E Grow Inc | Family Medicine | 810 W Indiana Ave, South Bend, IN 46613-1828 | 2007-07-23 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| 1225185739 | Michael J. O'connell D.o. Inc | Family Medicine | 17960 Cleveland Road, South Bend, IN 46635 | 2007-01-05 |
| 1679620579 | Mark R. Neff | Family Medicine | 804 Lancaster Dr, South Bend, IN 46614-2020 | 2007-01-04 |
| 1437216587 | David Wood Baxter | Family Medicine | 115 E Cripe St, South Bend, IN 46637-3402 | 2007-01-01 |
| 1477635944 | Alan Snell | Family Medicine | 837 East Cedar St., Ste 100, South Bend, IN 46617 | 2006-10-20 |
| 1437240694 | Brian Anthony Jacobs | Family Medicine | 610 N Michigan Street, Suite 308, South Bend, IN 46601 | 2006-09-27 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46614 |
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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.