BEACON MEDICAL GROUP, INC. (NPI# 1700187457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700187457 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | ELKHART CARDIOLOGY |
| Practice Address |
303 S Nappanee St Suite A Elkhart IN 46514-2066 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5742963338 |
| Practice Fax Number | 5742963332 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2016-09-21 |
| 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 | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
10-005017-1 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201004850A | 05 |
| Other Name | Type Code |
|---|---|
| Elkhart Cardiology | 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 |
| 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 |
| 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 |
303 S NAPPANEE ST SUITE A |
| City | ELKHART |
| State | IN |
| Zip Code | 46514-2066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578566675 | Pavan Ahuja | Internal Medicine | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2005-05-23 |
| 1114482676 | Marla M Troyer | Nurse Practitioner | 303 S Nappanee St, Elkhart, IN 46514-2098 | 2019-02-08 |
| 1144681941 | Jennifer Ann Hartl | Nurse Practitioner | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2016-03-08 |
| 1194078634 | Abigail Anne Johnson | Audiologist | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2012-10-22 |
| 1932402997 | Elkhart General Hospital, Inc. | General Acute Care Hospital | 303 S Nappanee St, Suite B, Elkhart, IN 46514-2066 | 2010-12-14 |
| 1043537020 | Emily A Mitchell | Surgery | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2010-04-29 |
| 1164664298 | Elkhart Clinic, LLC | Urology | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2009-04-06 |
| 1851531149 | Juanito U Uy Jr. | Internal Medicine | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2009-02-25 |
| 1063678878 | George Collins Nwadiaro | Internal Medicine | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2008-07-31 |
| 1710155718 | Eqdam N Radhi | Internal Medicine | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2008-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891333522 | Adam Collier | Nurse Anesthetist, Certified Registered | 600 Elkhart Boulvard, Elkhart, IN 46514 | 2019-12-12 |
| 1861034688 | Heart City Health Center, Inc. | Obstetrics & Gynecology | 1545 Cassopolis Street, Elkhart, IN 46514 | 2019-10-14 |
| 1982263398 | Fresenius Medical Care North Elkhart, LLC | Clinic/Center | 801 W Bristol St, Elkhart, IN 46514 | 2019-06-10 |
| 1487118220 | Hellenic Senior Living of Elkhart, LLC | Assisted Living Facility | 2528 Bypass Road, Elkhart, IN 46514 | 2019-01-25 |
| 1922595792 | Anna Cornelia Smith | Nutritionist | 51803 Tall Pines Dr, Elkhart, IN 46514 | 2018-04-17 |
| 1114438496 | Erika Lynn Farrell | Counselor | 3120 Suite B Windsor Court, Elkhart, IN 46514 | 2017-10-13 |
| 1740728948 | Michael Scheretie | Nurse Anesthetist, Certified Registered | 52866 Wildflower Ln, Elkhart, IN 46514 | 2017-02-08 |
| 1821355876 | Marcy Lynn Adams | Nurse Practitioner | 1104 W Bristol St, Elkhart, IN 46514 | 2012-04-16 |
| 1053694265 | Paul A. Price | Pharmacist | 1400 Cassopolis St., Elkhart, IN 46514 | 2011-09-23 |
| 1528362647 | Beacon Medical Group, Inc. | Internal Medicine | 500 Arcade Ave., Suite 400, Elkhart, IN 46514 | 2011-01-04 |
| Find all providers in zip 46514 | ||||
| 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 |
|---|---|---|---|---|
| 1679980320 | Beacon Medical Group Inc. | Internal Medicine | 25651 County Road 20, Elkhart, IN 46517-2310 | 2014-07-15 |
| 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.