BEACON MEDICAL GROUP, INC. (NPI# 1861421141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861421141 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Practice Address |
100 Navarre Pl Ste 6600 South Bend IN 46601 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746478800 |
| Practice Fax Number | 5746478811 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-08-19 |
| 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 | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201003280A | 05 | |
| IN | 201003280B | 05 | |
| IN | 201003280C | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 500 Arcade Ave Ste 200, Elkhart, IN 465142485 | 5742948404 | 5745231642 |
| 611 E Douglas Rd Ste 207, Mishawaka, IN 465451465 | 5742327227 | 5742322064 |
| 707 N Michigan St Ste 102, South Bend, IN 466011068 | 5746478542 | 5746478549 |
| 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 |
| 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 |
100 NAVARRE PL STE 6600 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851818132 | Laura C Wilkerson | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2017-08-27 |
| 1639521370 | Natalie Hauser | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2016-07-06 |
| 1912359662 | Heidi Schelstraete | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2016-07-06 |
| 1841695590 | Kyle Moser | Physician Assistant | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2014-10-23 |
| 1780098780 | Christopher Frederick Ketcham | Physical Medicine & Rehabilitation | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2014-06-17 |
| 1023364262 | Gina M. Connolly | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2012-07-25 |
| 1417243189 | Kashif Ajaz Shaikh | Neurological Surgery | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2011-06-21 |
| 1386802387 | Daniel H Fulkerson | Neurological Surgery | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2008-05-27 |
| 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 | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417243189 | Kashif Ajaz Shaikh | Neurological Surgery | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2011-06-21 |
| 1346475951 | Neal Balvant Patel | Neurological Surgery | 100 Navarre Pl, Suite 6600, South Bend, IN 46601-1156 | 2009-05-27 |
| 1386802387 | Daniel H Fulkerson | Neurological Surgery | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2008-05-27 |
| 1124050851 | Stephen M. Smith | Neurological Surgery | 100 Navarre Pl, Suite 6600, South Bend, IN 46601-1156 | 2006-07-06 |
| 1699703595 | Walter S. Langheinrich | Neurological Surgery | 100 Navarre Pl, Suite 6600, South Bend, IN 46601-1156 | 2006-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780146076 | T.s.shanks, Pllc | Neurological Surgery | 1919 State St Ste 250, New Albany, IN 47150-6805 | 2019-04-04 |
| 1326411158 | Stephen B Schroeder | Neurological Surgery | 2318 Turnberry Lane, Fort Wayne, IN 46804 | 2015-11-02 |
| 1326465725 | Hayder Jaffer | Neurological Surgery | 200 E 89th Ave Ste 3a, Merrillville, IN 46410-7319 | 2014-03-24 |
| 1083956015 | Us Medical & Business Consultants LLC | Neurological Surgery | 899 S College Mall Rd Ste 350, Bloomington, IN 47401-6301 | 2013-03-15 |
| 1659646917 | Shaheryar Faruq Ansari | Neurological Surgery | 8040 Clearvista Pkwy Ste 240, Indianapolis, IN 46256-4673 | 2012-03-19 |
| 1629367354 | Katrina Alise Ducis | Neurological Surgery | 705 Riley Hospital Dr Rm 1134, Indianapolis, IN 46202 | 2011-04-04 |
| 1639490857 | Karl Erach Balsara | Neurological Surgery | 705 Riley Hospital Dr # 1134, Indianapolis, IN 46202 | 2010-06-22 |
| 1265759955 | Chih-ta Lin | Neurological Surgery | 2525 W University Ave Ste 503, Muncie, IN 47303-3409 | 2010-04-21 |
| 1093030322 | Gregory J Loomis | Neurological Surgery | 1024 Dress Ln, Evansville, IN 47725-9596 | 2010-03-30 |
| 1730317090 | Graham Charles Hall | Neurological Surgery | 1550 E County Line Rd Ste 201, Indianapolis, IN 46227-1082 | 2009-06-25 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
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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.