BEACON MEDICAL GROUP, INC. (NPI# 1487038360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487038360 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP VEIN SPECIALISTS |
| Practice Address |
233 Florence Ave Granger IN 46530-8048 |
| Mailing Address |
710 E Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746473990 |
| Practice Fax Number | 5746473995 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2017-10-12 |
| Authorized Official Name | MR. JEFFREY P. COSTELLO (CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | Y |
| Parent Organization Name | BEACON HEALTH SYSTEM, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Vein Specialists | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
233 FLORENCE AVE |
| City | GRANGER |
| State | IN |
| Zip Code | 46530-8048 |
| 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 | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
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|---|---|---|---|---|
| 1306317565 | Donita Renee Morris | Radiology | 6910 N Oxford St, Indianapolis, IN 46220-2255 | 2018-12-16 |
| 1174099147 | Omnivas Nwi | Radiology | 8127 Merrillville Rd Ste 1, Merrillville, IN 46410-6306 | 2018-10-17 |
| 1669982492 | Us Access Care of Indianapolis, LLC | Radiology | 201 North Illinois St, 16th Floor - South Tower, Indianapolis, IN 46204-4618 | 2017-10-06 |
| 1396075982 | Ir Halum, LLC | Radiology | 5953 Calais Ct, Indianapolis, IN 46220-6004 | 2010-01-05 |
| 1952307480 | Joseph W Eke Jr. | Radiology | 711 S East St, Indianapolis, IN 46225-1317 | 2005-06-21 |
| 1053922849 | Ultrasonic Medical Specialists LLC | Radiology | 365 Conestoga Dr, Chesterton, IN 46304-1559 | 2020-08-13 |
| 1912522368 | Ng Medical Center LLC | Radiology | 5900 Hohman Ave, Hammond, IN 46320-2423 | 2020-06-11 |
| 1487176004 | Modern Vascular and Vein Center LLC | Radiology | 951 Transport Dr, Valparaiso, IN 46383-8434 | 2017-07-14 |
| 1154856789 | Xrc Clinical Radiology, LLC | Radiology | 121 S Saint Louis Blvd, South Bend, IN 46617-2924 | 2017-04-20 |
| 1952772782 | Nuvena Vein Center, LLC | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46845-1702 | 2015-10-20 |
| Find all providers with the same taxonomy | ||||
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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.