BEACON MEDICAL GROUP INC. (NPI# 1679980320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1679980320 |
Entity Type | Organization |
Organization Name | BEACON MEDICAL GROUP INC. |
Other Organization Name | BEACON MEDICAL GROUP CONCORD SPECIALTY CLINIC |
Practice Address |
25651 County Road 20 Elkhart IN 46517-2310 |
Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
Practice Telephone | 5745247128 |
Practice Fax Number | 5742966522 |
Mailing Telephone | 5746471610 |
Enumeration Date | 2014-07-15 |
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 | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Beacon Medical Group Concord Specialty Clinic | Doing Business As Name - Organization |
Street Address |
25651 COUNTY ROAD 20 |
City | ELKHART |
State | IN |
Zip Code | 46517-2310 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821199431 | Harley Wayne Yoder | Family Medicine | 25651 County Road 20, Elkhart, IN 46517-2310 | 2006-09-26 |
1225510522 | Kimberlee Lynn Acton | Nurse Practitioner | 25651 County Road 20, Elkhart, IN 46517-2310 | 2018-09-04 |
1730638990 | Elkhart Clinic, LLC | Clinic/Center | 25651 County Road 20, Elkhart, IN 46517-2310 | 2016-09-29 |
1558462101 | Concord Family Medicine PC | Family Medicine | 25651 County Road 20, Elkhart, IN 46517-2310 | 2006-09-26 |
1114028743 | Sam Joseph Borrelli | Family Medicine | 25651 County Road 20, Elkhart, IN 46517-2310 | 2006-09-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457743585 | Raymond Kraucunas | Pharmacist | 102 E Hively Ave., Elkhart, IN 46517 | 2015-02-26 |
1972834828 | Tyler Thomas Hawkins | Physical Therapy Assistant | 3965 Doral Ln., Elkhart, IN 46517 | 2010-01-15 |
1407008394 | Emily Anne Stults | Nurse Practitioner | 505 South Third St, Ste 160, Elkhart, IN 46517 | 2008-10-22 |
1902922453 | Assisted Living Concepts Inc | Assisted Living Facility | 27833 County Road 24, Elkhart, IN 46517 | 2007-03-22 |
1023145984 | Family Nursing Services, Inc. | Home Health | 58025 Cr 9, Elkhart, IN 46517 | 2007-02-27 |
1639178650 | Bethany L. Mcdaniel-vanderzwaag | Family Medicine | 3421 S Main St, Elkhart, IN 46517 | 2005-07-20 |
1770586737 | Timothy Alan Quist | Podiatrist | 24021 Us 33 East, Elkhart, IN 46517 | 2005-05-24 |
1649516469 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 2600 Morehouse Ave, Elkhart, IN 46517 | 2012-12-26 |
1538340716 | Timothy A Quist Dpm, PC | Podiatrist | 24021 Us 33 East, Elkhart, IN 46517 | 2007-11-16 |
1598889776 | Family Nursing Services, Inc. | Home Health | 58025 Cr 9, Elkhart, IN 46517 | 2007-03-16 |
Find all providers in zip 46517 |
Taxonomy Code | 207RC0000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Cardiovascular Disease |
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700187457 | Beacon Medical Group, Inc. | Internal Medicine | 303 S Nappanee St, Suite A, Elkhart, IN 46514-2066 | 2010-11-11 |
1679717771 | Troy A Weirick | Internal Medicine | 500 Arcade Ave, Suite 400, Elkhart, IN 46514-2477 | 2009-04-21 |
1609076777 | Nazmul Huda | Internal Medicine | 303 S Nappanee St, Ste A, Elkhart, IN 46514-2066 | 2007-07-18 |
1871598235 | Donald R. Westerhausen Jr. | Internal Medicine | 500 Arcade Ave, Ste 400, Elkhart, IN 46514-2477 | 2005-06-14 |
1326042029 | Charles A Mathis | Internal Medicine | 500 Arcade Ave, Ste 400, Elkhart, IN 46514-2477 | 2005-06-09 |
1265435861 | Wai H. Lee | Internal Medicine | 303 S Nappanee St, Suite A, Elkhart, IN 46514-2066 | 2005-05-27 |
1164425997 | Luisito C. Gonzales | Internal Medicine | 303 S Nappanee St, Suite A, Elkhart, IN 46514-2066 | 2005-05-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508489931 | Gentle Hearts Cardiovascular Institution LLC | Internal Medicine | 5221 W Lincoln Hwy, Suite 1a, Crown Point, IN 46307 | 2020-05-20 |
1689228587 | Milton Lethan Pressler | Internal Medicine | 1243 Skytag Dr, Carmel, IN 46032-6301 | 2019-07-29 |
1790231926 | Perry County Cardiology LLC | Internal Medicine | 8735 State Road 37, Suite B, Tell City, IN 47586-8349 | 2016-08-28 |
1164887329 | Heart and Vascular Center, LLC | Internal Medicine | 604 Cambridge Ct, 1b, Munster, IN 46321-2458 | 2015-12-15 |
1487061131 | Beacon Medical Group, Inc. | Internal Medicine | 2400 N Ventura Way, Lagrange, IN 46761-4101 | 2014-07-15 |
1174939003 | Hassan Majed Mostafa | Internal Medicine | 13100 E 136th St Ste 3000, Fishers, IN 46037-9817 | 2014-07-11 |
1619306222 | Cardiology Associates of Nw Indiana, PC | Internal Medicine | 10010 Don Powers Dr, Munster, IN 46321-4054 | 2013-11-04 |
1487996450 | Richard Bruce Wenzler | Internal Medicine | 875 Sugarbush Rdg, Zionsville, IN 46077-1911 | 2013-03-18 |
1164774816 | Jeffrey Scott Riesmeyer | Internal Medicine | 10582 Brooks School Rd, Fishers, IN 46037-9720 | 2012-10-04 |
1124381751 | Robert W Godley II | Internal Medicine | Community Physicians of Indiana, Inc., 1402 E. County Line Rad, Indianapolis, IN 46227-0963 | 2012-06-19 |
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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.