BEACON MEDICAL GROUP, INC. (NPI# 1205852365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205852365 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP EDWARDSBURG |
| Practice Address |
27082 W. Main Street Edwardsburg MI 49112-9334 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 2696638288 |
| Practice Fax Number | 2696632426 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2016-10-27 |
| Authorized Official Name | MR. JEFF P COSTELLO (CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 06-005017-1 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100220310A | 05 | |
| MI | 080A410090 | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Edwardsburg | 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 |
| 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 |
| 1306899554 | Beacon Medical Group, Inc. | Dermatology | 6913 N Main St Ste 100, Granger, IN 46530 | 2006-05-18 |
| 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 |
27082 W. MAIN STREET |
| City | EDWARDSBURG |
| State | MI |
| Zip Code | 49112-9334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801068226 | Jonathan Carl Harroff | Dentist | 69171 E Elkhart Rd, Edwardsburg, MI 49112 | 2008-03-26 |
| 1578619078 | Beacon Health Ventures Michigan, Inc. | Home Health | 69045 M-62, Suite A-1, Edwardsburg, MI 49112 | 2007-01-26 |
| 1023231099 | Lindsey Danielle Lira | Family Medicine | 27082 Main St, Edwardsburg, MI 49112 | 2007-04-10 |
| 1699898007 | Catherine Ann Bazata | Occupational Therapist | 26875 Church St., Edwardsburg, MI 49112-0367 | 2007-04-09 |
| 1447851183 | Cynthia Jean Werner | Registered Nurse | 70067 Beach Dr, Edwardsburg, MI 49112-8434 | 2020-11-07 |
| 1801831375 | Ontwa Jefferson Mason Milton Calvin Tnshps & Village of Edwardsburg | Ambulance | 26273 E Shore Dr, Edwardsburg, MI 49112-8453 | 2006-06-18 |
| 1164030243 | April Christine Chew | Nurse Practitioner | 71491 Adamsville Rd, Edwardsburg, MI 49112-8720 | 2020-07-15 |
| 1851789234 | Lg's Whispering Pines | Custodial Care Facility | 69350 Christiana Creek Dr, Edwardsburg, MI 49112-8731 | 2015-01-07 |
| 1790057198 | Joshua Rodgers Jones | Chiropractor | 69821 M 62, Ste 12, Edwardsburg, MI 49112-8807 | 2012-01-31 |
| 1235384041 | Clear Choice Chiropractic of Edwardsburg, P.C. | Massage Therapist | 69821 M 62 Ste 12, Edwardsburg, MI 49112-8807 | 2008-11-20 |
| Find all providers in zip 49112 | ||||
| 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 |
|---|---|---|---|---|
| 1275560583 | Maureen Ziboh | Family Medicine | 69045 M 62 Ste B, Edwardsburg, MI 49112-9168 | 2006-06-26 |
| 1073559415 | George Erving Drake | Family Medicine | 68449 Scott St, Edwardsburg, MI 49112-9504 | 2006-06-22 |
| 1578562070 | Robert M Knox | Family Medicine | 27082 Main St, Edwardsburg, MI 49112-9334 | 2005-07-18 |
| 1023231099 | Lindsey Danielle Lira | Family Medicine | 27082 Main St, Edwardsburg, MI 49112 | 2007-04-10 |
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|---|---|---|---|---|
| 1578163465 | Salta of Auburn Hills | Family Medicine | 2191 S South Blvd, Suite 101c, Pontiac, MI 48326-3481 | 2020-10-29 |
| 1396342606 | Kiwi Virtual Health Care Pllc | Family Medicine | 40618 Blythefield Ln, Canton, MI 48188-2251 | 2020-10-08 |
| 1447867619 | Bashar Yalldo Md Plc | Family Medicine | 14700 Farmington Rd Ste 105, Livonia, MI 48154-5434 | 2020-09-30 |
| 1245847342 | Nuha Bakkal | Family Medicine | 1422 Mill Pond Dr, Waterford, MI 48327-3088 | 2020-09-23 |
| 1710592050 | Chippewa County War Memorial Hospital Inc | Family Medicine | 391 E M 134, Cedarville, MI 49719-9451 | 2020-09-14 |
| 1184238966 | Med Clubs | Family Medicine | 2575 Hummingbird Dr, Holt, MI 48842-9430 | 2020-08-31 |
| 1457961054 | Danna Zevy | Family Medicine | 107 S Washington Ave Apt 401, Saginaw, MI 48607-1258 | 2020-08-07 |
| 1194342808 | Zachary Hillman Do Pllc | Family Medicine | 1794 N Lapeer Rd Ste A, Lapeer, MI 48446-7664 | 2020-06-29 |
| 1336765445 | Spectrum Health United | Family Medicine | 7188 Avenue B, Vestaburg, MI 48891-9502 | 2020-06-24 |
| 1477179711 | Spectrum Health United | Family Medicine | 1324 N County Line Rd, Blanchard, MI 49310-9303 | 2020-06-23 |
| Find all providers with the same taxonomy | ||||
| City | EDWARDSBURG |
| Zip Code | 49112 |
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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.