BEACON MEDICAL GROUP, INC. (NPI# 1821222829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821222829 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Practice Address |
615 N Michigan St First Floor Hospitalist Suite South Bend IN 46601 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746473050 |
| Practice Fax Number | 5746471094 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2020-08-04 |
| Authorized Official Name | MR. JEFFREY P. COSTELLO (VP/CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RS0010X |
Internal Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | 01049858A | IN | Allopathic & Osteopathic Physicians |
| N | 207VF0040X |
Obstetrics & Gynecology Specialization: Female Pelvic Medicine and Reconstructive Surgery |
01049858A | IN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 01049858A | IN | Allopathic & Osteopathic Physicians |
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 208M00000X | Hospitalist | 01049858A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300012878 | 05 | |
| IN | 300013260 | 05 | |
| IN | 300013073 | 05 | |
| IN | 300013675 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 Navarre Pl Ste 4440, South Bend, IN 466011171 | 5746475300 | 5746475305 |
| 100 Navarre Pl Ste 5500, South Bend, IN 466011172 | 5746475200 | 5746475210 |
| 100 Navarre Pl Ste 5500, South Bend, IN 466011172 | 5746475300 | 5746475305 |
| 1020 High Rd, Bremen, IN 465061093 | 5743099967 | 5743099968 |
| 111 W Jefferson Blvd Ste 100, South Bend, IN 466011993 | 5746471670 | 5746476927 |
| 1400 E 9th St, Rochester, IN 469758931 | 5743099965 | 5743099966 |
| 200 E Jackson Blvd Ste 130, Elkhart, IN 465163513 | 5743895565 | 5743895566 |
| 2240 Karisa Dr Ste 1, Goshen, IN 465266943 | 5743094969 | 5743099970 |
| 3220 Beacon Parkway, Suite 200, Granger, IN 46530 | 5749998838 | 5749998839 |
| 3221 Beacon Pkwy, Granger, IN 465307196 | 5746471670 | 5746476927 |
| 621 Memorial Dr Ste 302, South Bend, IN 466011073 | 5743673800 | 5743673801 |
| 621 Memorial Dr Ste 612, South Bend, IN 466011085 | 5746477975 | 5746477978 |
| 621 Memorial Dr Ste 624, South Bend, IN 466011063 | 5746478177 | 5746478536 |
| 6301 University Commons Ste 420, South Bend, IN 466351416 | 5749682832 | 5749682835 |
| 6913 N Main St Ste 100, Granger, IN 465308039 | 5746476400 | 5746472951 |
| 707 N Michigan St Ste 102, South Bend, IN 466011068 | 5743673800 | 5743673801 |
| 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 |
615 N MICHIGAN ST FIRST FLOOR HOSPITALIST SUITE |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003801283 | Russell F Johnson | Radiology | 615 N Michigan St, 1st Floor, South Bend, IN 46601-1033 | 2005-09-14 |
| 1265048078 | Sarah Ellen Pritt | Technician | 615 N Michigan St, South Bend, IN 46601-1087 | 2020-09-17 |
| 1740803238 | Taylor Reinhardt | Physician Assistant | 615 N Michigan St, South Bend, IN 46601-1033 | 2020-05-19 |
| 1720613268 | Jennifer Lynn Boyd | Pharmacist | 615 N Michigan St, South Bend, IN 46601-1087 | 2020-03-05 |
| 1104451798 | Ryan Lipinski | Pharmacist | 615 N Michigan St, South Bend, IN 46601-1033 | 2020-03-04 |
| 1669007241 | Alexandra Rain Ross | Pharmacist | 615 N Michigan St, South Bend, IN 46601-1087 | 2020-03-04 |
| 1538717848 | Emily Mastelou-page | Nurse Practitioner | 615 N Michigan St, South Bend, IN 46601-1033 | 2019-08-29 |
| 1477021038 | Ashlee Dennise Swafford | Physician Assistant | 615 N Michigan St, South Bend, IN 46601-1033 | 2018-11-12 |
| 1487132114 | South Bend Emergency Physicians, Inc | Emergency Medicine | 615 N Michigan St, South Bend, IN 46601-1033 | 2018-08-03 |
| 1962993386 | Gail Gronek Weismann | Dietitian, Registered | 615 N Michigan St, South Bend, IN 46601-1033 | 2018-05-21 |
| Find all providers in the same location | ||||
| 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 Code | 208M00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Hospitalist |
| Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. |
| Notes: Source: American Society of Hospital Medicine, 2007. http://www.hospitalmedicine.org/ [7/1/2009: definition aded] Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions. There is no board certification for the specialty at this point. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447865159 | Nichole Renee Sebesky | Hospitalist | 629 Park Dr, Franklin, IN 46131-7685 | 2020-09-10 |
| 1407239114 | Thomas Ryan Cervone | Hospitalist | Tristar Southern Hills Medical, 391 Wallace Road, Nashville, IN 37211 | 2015-06-30 |
| 1104194547 | Select Specialty Hospital - Evansville, LLC | Hospitalist | 400 Se 4th St, Evansville, IN 47713-1206 | 2011-12-13 |
| 1073826780 | Indiana University Health Starke Hospital LLC | Hospitalist | 102 East Culver Road, Knox, IN 46534-2216 | 2010-07-22 |
| 1295863199 | Jason S. Henderson | Hospitalist | 6404 Cotton Bay Dr N, Indianapolis, IN 46254-4528 | 2007-03-01 |
| 1619087707 | Shelene S. Ruggio | Hospitalist | 503 Steeplechase Dr, Auburn, IN 46706-9127 | 2006-08-30 |
| 1427161801 | Krishna Datta | Hospitalist | 2520 E. Dupont Road, Fort Wayne, IN 46825 | 2006-08-17 |
| 1003884404 | Srinivasu Kesa | Hospitalist | 3471 Muirfield Way, Carmel, IN 46032 | 2006-03-10 |
| 1154321099 | Johnson Memorial Hospital | Hospitalist | 1155 W Jefferson St, Ste 202, Franklin, IN 46131-2732 | 2005-07-21 |
| 1598387250 | Dana Oberg | Hospitalist | 1915 Lake Ave, Plymouth, IN 46563-9366 | 2020-05-15 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
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.