BEACON MEDICAL GROUP, INC. (NPI# 1437574530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437574530 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP THREE RIVERS SPECIALTY CLINIC |
| Practice Address |
711 S Health Pkwy Ste 1 Medical Office Building #1 Three Rivers MI 49093-8354 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 2692739691 |
| Practice Fax Number | 2692739631 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2016-08-30 |
| Authorized Official Name | JEFFREY P. COSTELLO (CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Three Rivers Specialty Clinic | 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 |
| 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 |
| 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 |
711 S HEALTH PKWY STE 1 MEDICAL OFFICE BUILDING #1 |
| City | THREE RIVERS |
| State | MI |
| Zip Code | 49093-8354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366833865 | Brandy Peterson | Technician/Technologist | 18511 South River Rd, Three Rivers, MI 49093 | 2015-02-05 |
| 1073933958 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 800 S Us Highway 131 Ste A, Three Rivers, MI 49093 | 2014-04-18 |
| 1184927865 | Autumn Brooke Walton | Counselor | 30 N. Main St., Three Rivers, MI 49093 | 2010-12-17 |
| 1972730877 | Peggy Cahue-kuipers | Counselor | 1020 Millard, Three Rivers, MI 49093 | 2009-06-18 |
| 1215101530 | Raelene Mckeon Kent | Pediatrics | 601 S. Us 131, Three Rivers, MI 49093 | 2008-04-17 |
| 1407043722 | Assisted Living Concepts Inc | Assisted Living Facility | 1215 Ne Elm Street, Three Rivers, MI 49093 | 2007-10-01 |
| 1205047552 | Judith Anderson | Psychologist | 131 Enterprise St, Three Rivers, MI 49093 | 2007-05-25 |
| 1619013240 | Michael Angelo Cucci | Dentist | 221 North Hooker Ave, Three Rivers, MI 49093 | 2007-01-30 |
| 1659421204 | Meijer Inc | Durable Medical Equipment & Medical Supplies | 800 S Us 131, Three Rivers, MI 49093 | 2007-01-12 |
| 1679622401 | Gail Marjorie Woods | Dentist | 57175 North Main Street, Three Rivers, MI 49093 | 2007-01-10 |
| Find all providers in zip 49093 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104445980 | Anuja Dharap | Otolaryngology | 35630 Grand River Ave Apt 217, Farmington Hills, MI 48335-3120 | 2020-04-13 |
| 1598311334 | Cogent Medical Group Pllc | Otolaryngology | 28300 Orchard Lake Rd Ste 101, Farmington Hills, MI 48334-3704 | 2019-08-16 |
| 1073025334 | Robert J Stachler Md PC | Otolaryngology | 33200 W. 14 Mile Rd., Ste. 240, West Bloomfield, MI 48322 | 2017-10-26 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1174905822 | Scott Jacob Schwartz | Otolaryngology | 6900 Orchard Lake Rd Ste 314, West Bloomfield, MI 48322-3457 | 2015-06-18 |
| 1669868402 | Cameron M Heilbronn | Otolaryngology | 21000 E 12 Mile Rd Ste 111, Saint Clair Shores, MI 48081-1156 | 2015-04-08 |
| 1104230523 | Gary Zachary White | Otolaryngology | 300 North Ave Ste 1400, Battle Creek, MI 49017 | 2014-06-13 |
| 1124361621 | Eric Fahed Succar | Otolaryngology | 44200 Woodward Ave Ste 201, Pontiac, MI 48341-5045 | 2013-04-03 |
| 1396086286 | Nathan Vandjelovic | Otolaryngology | 4201 Saint Antoine St # 9c, Detroit, MI 48201-2153 | 2013-03-03 |
| 1497091078 | Henry L Singer | Otolaryngology | 2341 Tor Ln, Petoskey, MI 49770-9768 | 2012-12-30 |
| Find all providers with the same taxonomy | ||||
| City | THREE RIVERS |
| Zip Code | 49093 |
Please comment or provide details below to improve the information on BEACON MEDICAL GROUP, INC..
| 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.