BEACON MEDICAL GROUP, INC. (NPI# 1437100161) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437100161 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP SOUTHEAST NEIGHBORHOOD HEALTH CENTER |
| Practice Address |
1708 High St South Bend IN 46613-2633 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746471400 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2016-08-29 |
| Authorized Official Name | JEFFREY COSTELLO (VP-CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01059718A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200114230A | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Southeast Neighborhood Health Center | 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 |
1708 HIGH ST |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46613-2633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699763409 | Patricia Ann Corbett | Nurse Practitioner | 1708 High St, South Bend, IN 46613-2633 | 2005-10-06 |
| 1811465602 | Healthlinc, Inc | Clinic/Center | 1708 High St, South Bend, IN 46613-2633 | 2018-11-09 |
| 1528358405 | Luann Marie Tracey | Nurse Practitioner | 1708 High St, South Bend, IN 46613-2633 | 2011-04-13 |
| 1013948348 | Jon Andrew Shull | Family Medicine | 1708 High St, South Bend, IN 46613-2633 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730330721 | Mindy Lynne Gradeless | Social Worker | 229 East Ewing Avenue, South Bend, IN 46613 | 2008-10-08 |
| 1689836405 | Staci-marie Balog Norman | Pharmacist | 760 West Cotter Street, South Bend, IN 46613 | 2008-07-02 |
| 1659386779 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1945 Lincolnway East, South Bend, IN 46613 | 2006-07-29 |
| 1003026642 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2105 Wabash St, South Bend, IN 46613-1138 | 2007-05-23 |
| 1366702060 | Clara M Davis | Private Vehicle | 1719 W Dubail St, South Bend, IN 46613-1216 | 2012-05-29 |
| 1215923313 | Gregory Matthew Ferro | Family Medicine | 1832 Prairie Ave, South Bend, IN 46613-1400 | 2005-09-23 |
| 1508330002 | Homeworks Construction Inc | Durable Medical Equipment & Medical Supplies | 1511 Pulaski St, South Bend, IN 46613-1404 | 2019-01-17 |
| 1477763415 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1917 S Walnut St, South Bend, IN 46613-1541 | 2007-05-22 |
| 1013117472 | Ronald E Grow Inc | Family Medicine | 810 W Indiana Ave, South Bend, IN 46613-1828 | 2007-07-23 |
| 1437444692 | Life Treatment Centers | Substance Abuse Rehabilitation Facility | 1402 S Michigan St, South Bend, IN 46613-2214 | 2011-06-16 |
| Find all providers in zip 46613 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285998146 | Thomas Larsen | Family Medicine | 4440 Portage Ave, South Bend, IN 46628-9570 | 2012-06-26 |
| 1316180318 | Paul Angelo Carl Macri | Family Medicine | 2012 Cedar St, South Bend, IN 46617-2542 | 2009-04-07 |
| 1285818591 | Jaroslaw Kuna | Family Medicine | 320 S Saint Joseph St Ste 300, South Bend, IN 46601-2308 | 2007-12-21 |
| 1013117472 | Ronald E Grow Inc | Family Medicine | 810 W Indiana Ave, South Bend, IN 46613-1828 | 2007-07-23 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| 1225185739 | Michael J. O'connell D.o. Inc | Family Medicine | 17960 Cleveland Road, South Bend, IN 46635 | 2007-01-05 |
| 1679620579 | Mark R. Neff | Family Medicine | 804 Lancaster Dr, South Bend, IN 46614-2020 | 2007-01-04 |
| 1437216587 | David Wood Baxter | Family Medicine | 115 E Cripe St, South Bend, IN 46637-3402 | 2007-01-01 |
| 1477635944 | Alan Snell | Family Medicine | 837 East Cedar St., Ste 100, South Bend, IN 46617 | 2006-10-20 |
| 1437240694 | Brian Anthony Jacobs | Family Medicine | 610 N Michigan Street, Suite 308, South Bend, IN 46601 | 2006-09-27 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46613 |
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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.