BEACON MEDICAL GROUP, INC. (NPI# 1487061131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487061131 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP LAGRANGE SPECIALTY CLINIC |
| Practice Address |
2400 N Ventura Way Lagrange IN 46761-4101 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5745247123 |
| Practice Fax Number | 5742966522 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2016-08-30 |
| Authorized Official Name | JEFFREY 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 |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group LaGrange Specialty Clinic | 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 |
| 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 |
| 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 |
2400 N VENTURA WAY |
| City | LAGRANGE |
| State | IN |
| Zip Code | 46761-4101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962049007 | Darlene L. Schlotterback | Physical Therapist | 207 N. Townline Rd, Lagrange, IN 46761 | 2019-12-09 |
| 1083264006 | Kimberly A Hershberger | Pharmacist | 0975 N 00 Ew, Lagrange, IN 46761 | 2019-09-12 |
| 1134775554 | Kristy Jo Roth | Pharmacist | 0975n 00 Ew, Lagrange, IN 46761 | 2019-08-12 |
| 1235372277 | Lagrange Surgery Center, LLC | Clinic/Center | 2500 Ventura Way, Lagrange, IN 46761 | 2009-04-07 |
| 1568565265 | Hook Superx LLC | Pharmacy | 975n Ooew, Lagrange, IN 46761 | 2006-09-07 |
| 1558305326 | Craig L Nelson Dds Inc | Dentist | 405 Union Street, Lagrange, IN 46761 | 2006-06-15 |
| 1134184781 | Michael W Conway | Family Medicine | 207 N Townline Rd Ste 104, Lagrange, IN 46761 | 2006-04-18 |
| 1548220544 | Millard Reed Taylor | Family Medicine | 2120 N Detroit St, Lagrange, IN 46761 | 2006-03-24 |
| 1891791414 | Larry Best | Podiatrist | 400 1/2 Union Street, Lagrange, IN 46761 | 2005-06-28 |
| 1972140010 | Vickie L. Pletcher | Physical Therapy Assistant | 207 N. Townline Rd., Lagrange, IN 46761 | 2019-12-09 |
| Find all providers in zip 46761 | ||||
| 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 |
|---|---|---|---|---|
| 1578558714 | Alexander T Gedevanishvili | Internal Medicine | 1602 Vernon Rd Ste 300, Lagrange, GA 30240 | 2005-09-14 |
| 1801138045 | Heart & Vascular Care of Georgia PC | Internal Medicine | 505 Jenkins St, Lagrange, GA 30240-4225 | 2013-03-26 |
| 1558592089 | West Georgia Medical Center Inc | Internal Medicine | 1551 Doctors Dr, Bldg 200, Lagrange, GA 30240-4139 | 2009-07-31 |
| 1407091887 | Lagrange Cardiovascular Center LLC | Internal Medicine | 301 Medical Dr, Suite 506, Lagrange, GA 30240-4144 | 2008-12-12 |
| 1891738118 | Angampally G Rajeev | Internal Medicine | 1551 Doctors Drive, Bldg 200, Lagrange, GA 30240-4139 | 2006-06-14 |
| 1912949173 | James A Brennan | Internal Medicine | 303 Smith St, Clark-holder Clinic, P.a., Lagrange, GA 30240-2745 | 2006-06-12 |
| 1134188493 | Kathryn Amanda Mcfarland | Internal Medicine | 303 Smith St, Lagrange, GA 30240-2745 | 2006-03-23 |
| 1639164874 | Thomas B Gore | Internal Medicine | 1551 Doctors Dr, Building 200, Lagrange, GA 30240-4139 | 2005-09-14 |
| 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 |
| 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 |
| 1306146220 | St Catherine Hospital Inc | Internal Medicine | 7217 Indianapols Blvd, Hammond, IN 46324-2213 | 2010-10-26 |
| 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.