BEACON MEDICAL GROUP, INC.


Address: 707 N Michigan St Ste 400, South Bend, IN 46601-1071
Phone: 5746478470

BEACON MEDICAL GROUP, INC. (NPI# 1629376645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1629376645
Entity Type Organization
Organization Name BEACON MEDICAL GROUP, INC.
Other Organization Name BEACON MEDICAL GROUP BEHAVIORAL HEALTH SOUTH BEND
Practice Address 707 N Michigan St Ste 400
South Bend
IN 46601-1071
Mailing Address 710 N Niles Ave
South Bend
IN 46617-1924
Practice Telephone 5746478470
Practice Fax Number 5746478475
Mailing Telephone 5746471610
Enumeration Date 2011-03-01
Last Update Date 2017-10-12
Authorized Official Name JEFFREY P COSTELLO (VP/CFO)
Authorized Official Telephone 5746473549
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 2084P0804X Psychiatry & Neurology
Specialization: Child & Adolescent Psychiatry
01052982A IN Allopathic & Osteopathic Physicians
N 2084P0805X Psychiatry & Neurology
Specialization: Geriatric Psychiatry
01052982A IN Allopathic & Osteopathic Physicians
Y 2084P0800X Psychiatry & Neurology
Specialization: Psychiatry
01052982A IN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IN 201013730A 05

Other Provider/Organization Names

Other Name Type Code
Beacon Medical Group Behavioral Health South Bend Doing Business As Name - Organization

Other Provider IDs and Locations

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

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities BEACON MEDICAL GROUP, INC. 4601 Glendale Court, Savage, MN 55378-2543

Office Location

Street Address 707 N MICHIGAN ST STE 400
City SOUTH BEND
State IN
Zip Code 46601-1071

Providers in the same location

NPI Name Taxonomy Address Enumeration
1114189305 Ahmed Zakria Elmaadawi Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2008-06-27
1528698081 Sarah E Geyer Nurse Practitioner 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2020-01-23
1730698267 Jennifer Jean Loop-miller Nurse Practitioner 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2017-09-27
1154735140 Michael Workman Nurse Practitioner 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2014-06-17
1619381993 Julie Coyle Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601 2014-06-16
1114272184 Joshua Lotfallah Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2012-07-17
1821386707 Jennifer Clare Prins Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2011-07-13
1437442555 Vicente Gonzaga Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2011-05-23
1124252879 Elizabeth A Hay Pediatrics 707 N Michigan St Ste 400, South Bend, IN 46601 2009-05-11

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447610449 David Thomas Hearing Instrument Specialist 808 S Michigan St., South Bend, IN 46601 2016-03-03
1285072454 Kevin Francis Cumper Internal Medicine 621 Memorial Dr Ste 624, South Bend, IN 46601 2013-06-11
1952605560 Robert Lusk Bonham Dentist 1222 L.w.e., So. Bend, IN 46601 2010-12-23
1649580911 Daniel Scott Debrule Psychologist 211 W. Washington Street, Suite 2311, South Bend, IN 46601 2010-10-20
1528390770 Luke Alfred White Internal Medicine 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 2010-02-12
1548497837 Tmg Home Health Care Home Health 108 N Main St #305, South Bend, IN 46601 2009-06-15
1225283039 Jody L. Hughes Counselor 202 S. Michigan Street, Suite 875, South Bend, IN 46601 2008-11-20
1740432574 Amanda Jayne Quicksall Social Worker 611 Lincolnway W, South Bend, IN 46601 2008-10-10
1952565772 Thomas P Judd Dentist 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 2008-07-10
1851590269 Warren Larry Penrod Nurse Practitioner 333 W. Western Ave, South Bend, IN 46601 2007-07-16
Find all providers in zip 46601

Taxonomy Information

Taxonomy Code 2084P0800X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Psychiatry

Taxonomy Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1558794206 Frances Psychiatry & Neurology 219 N Dixie Way, Suite 135, South Bend, IN 46637-3369 2013-08-16
1114189305 Ahmed Zakria Elmaadawi Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601-1071 2008-06-27
1700090677 Jennifer S. Knapp Psychiatry & Neurology 3220 E Jefferson Blvd, South Bend, IN 46615-3028 2007-05-10
1134206576 Kearn David Hinchman Psychiatry & Neurology 53779 Generations Drive, Suite 1, South Bend, IN 46635 2006-11-01
1336234756 Khutb Mohammed Uddin Psychiatry & Neurology 239 N Dixie Way, South Bend, IN 46637-3309 2006-10-03
1053405779 Brian K Esch Psychiatry & Neurology 218 W. Washington St., Suite 430, South Bend, IN 46601 2006-10-03
1659335636 Mitchell Robert Goldstein Psychiatry & Neurology 107 N Eddy St, South Bend, IN 46617-2920 2006-04-14
1811985062 Gregory Ernest Shadid Psychiatry & Neurology 2043 S Bend Ave # 233, South Bend, IN 46637-5686 2005-10-12
1619381993 Julie Coyle Psychiatry & Neurology 707 N Michigan St Ste 400, South Bend, IN 46601 2014-06-16
1336574748 Joan Louise Pontius Psychiatry & Neurology 219 N Dixie Way, Suite135, South Bend, IN 46637-3369 2013-09-05
Find all providers in SOUTH BEND

Competitor

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City SOUTH BEND
Zip Code 46601

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Dataset Information

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.

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