BEACON MEDICAL GROUP, INC. (NPI# 1295087500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295087500 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Practice Address |
1753 Fulton St Elkhart IN 46514-1927 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5742939448 |
| Practice Fax Number | 5742939480 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2017-10-12 |
| Authorized Official Name | MR. JEFFREY P COSTELLO (CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 231H00000X | Audiologist | Speech, Language and Hearing Service Providers | ||
| Y | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1753 Fulton St, Elkhart, IN 465141927 | 5742939448 | 5742939480 |
| 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 |
1753 FULTON ST |
| City | ELKHART |
| State | IN |
| Zip Code | 46514-1927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215936737 | James R Miller | General Practice | 1753 Fulton St, Elkhart, IN 46514-1927 | 2005-07-18 |
| 1750941779 | Jordan Leigh Bergstrom | Audiologist | 1753 Fulton St, Elkhart, IN 46514-1927 | 2019-06-20 |
| 1831321942 | Diego Heredia Vintimilla | Internal Medicine | 1753 Fulton St, Elkhart, IN 46514-1927 | 2009-08-24 |
| 1275735581 | John S Gilbert | Otolaryngology | 1753 Fulton St, Elkhart, IN 46514-1927 | 2007-05-31 |
| 1376607028 | Amberly L Burger | Internal Medicine | 1753 Fulton St, Elkhart, IN 46514-1927 | 2006-12-20 |
| 1508950122 | Eliud Irizarry Claudio | Psychiatry & Neurology | 1753 Fulton St, Suite A, Elkhart, IN 46514-1927 | 2006-10-03 |
| 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 | 207YX0905X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngology/Facial Plastic Surgery |
| An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275735581 | John S Gilbert | Otolaryngology | 1753 Fulton St, Elkhart, IN 46514-1927 | 2007-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073990867 | Ear, Nose, Throat, Sinus | Otolaryngology | 8840 Calumet Ave Ste 101, Munster, IN 46321-2546 | 2015-04-30 |
| 1376882399 | Unity Healthcare, LLC | Otolaryngology | 1345 Unity Pl Ste 110a, Lafayette, IN 47905-5760 | 2013-02-12 |
| 1528040045 | Kyle D. Loy | Otolaryngology | 2606 Veterans Memorial Pkwy S, Suite 1, Lafayette, IN 47909-9192 | 2005-11-18 |
| 1467851139 | Great Lakes Healthcare Specialists LLC | Otolaryngology | 900 Ridge Road, Suite E, Munster, IN 46321-1727 | 2014-08-19 |
| 1669702106 | St Margaret Mercy Healthcare Centers, Inc | Otolaryngology | 24 Joliet St Ste 101, Dyer, IN 46311-1705 | 2010-01-06 |
| 1417186487 | Duran Back Pain Chiropractic Clinic, Inc. | Otolaryngology | 302 Duran Dr, Shelbyville, IN 46176-1986 | 2009-07-10 |
| 1487892766 | Richard Kurtz Md Professional Corporation | Otolaryngology | 3351 N Meridian St, Suite 100, Indianapolis, IN 46208-4674 | 2009-01-26 |
| 1811152572 | St. Margaret Mercy Healthcare Centers, Inc | Otolaryngology | 5500 Hohman Avenue, Suite 2a, Hammond, IN 46320-1942 | 2008-07-22 |
| 1861609216 | Jatin R Patel | Otolaryngology | 8840 Calumet Ave Ste 101, Munster, IN 46321-2546 | 2007-05-16 |
| 1871715011 | Peter Nicholas Rigas II | Otolaryngology | 12188a N Meridian St, Suite 375, Carmel, IN 46032-4406 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
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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.