BEACON MEDICAL GROUP, INC. (NPI# 1558652347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558652347 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP SPECIALISTS BREMEN |
| Practice Address |
1020 High Rd Bremen IN 46506-1093 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5745468044 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2016-08-30 |
| 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 |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 07001058A | IN | Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Specialists Bremen | 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 |
1020 HIGH RD |
| City | BREMEN |
| State | IN |
| Zip Code | 46506-1093 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376525303 | Diane M. Mackie & Associates, PC | Pathology | 1020 High Rd, Bremen, IN 46506-0008 | 2005-11-16 |
| 1023588811 | Community Hospital of Bremen | Pharmacy | 1020 High Rd, Bremen, IN 46506-1093 | 2018-12-05 |
| 1306381041 | Elkhart Clinic, LLC | Clinic/Center | 1020 High Rd, Bremen, IN 46506-1093 | 2017-01-05 |
| 1124269402 | Brittanee Nelson | Dietitian, Registered | 1020 High Rd, Bremen, IN 46506-1093 | 2009-03-16 |
| 1477597631 | Community Hospital of Bremen, Inc. | Medicare Defined Swing Bed Unit | 1020 High Rd, Bremen, IN 46506-1093 | 2006-06-16 |
| 1972585909 | Diane M Mackie | Pathology | 1020 High Rd, Bremen, IN 46506-0008 | 2005-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356564447 | Laura A Both | Family Medicine | 1144 W. Plymouth St., Bremen, IN 46506 | 2007-04-10 |
| 1770638934 | Bremen Public Schools | Local Education Agency (LEA) | 512 West Grant, Bremen, IN 46506 | 2007-01-25 |
| 1194764449 | Sandra R. Brown | Obstetrics & Gynecology | 1144 W Plymouth St, Bremen, IN 46506 | 2006-06-05 |
| 1568417004 | Community Hospital of Bremen, Inc | General Acute Care Hospital | 1020 High Road, Bremen, IN 46506 | 2006-05-23 |
| 1902017080 | Community Hospital of Bremen, Inc. | Family Medicine | 1020 High Road, Bremen, IN 46506 | 2007-05-24 |
| 1184771461 | James Wellington Lowe | Emergency Medicine | 1020 High Road, Bremen, IN 46506 | 2007-01-05 |
| 1689680977 | John Keith Frey | Emergency Medicine | 1020 High Road, Bremen, IN 46506-0008 | 2006-07-31 |
| 1841698602 | Activate Healthcare - Bremen Clinic | Clinic/Center | 710 W Dewey St, Bremen, IN 46506-1185 | 2014-12-10 |
| 1598098766 | Bremen Chiropractic Center PC | Chiropractor | 204 E Plymouth Street, Bremen, IN 46506-1238 | 2009-09-04 |
| 1063561793 | Wiliam George Garl | Chiropractor | 204 E Plymouth St, Bremen, IN 46506-1238 | 2007-01-10 |
| Find all providers in zip 46506 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003472721 | Roman Podiatry Partners Inc | Podiatrist | 2308 N. Roosevelt, Valparaiso, IN 46383 | 2019-05-17 |
| 1770040081 | Apex Podiatry, Inc. | Podiatrist | 1720 Lafayette Rd Ste 3, Crawfordsville, IN 47933-4604 | 2019-02-22 |
| 1982176913 | A-warnock LLC | Podiatrist | 1103 Central Park Blvd N, Greenwood, IN 46143-7312 | 2019-01-02 |
| 1336658095 | Jenkins Podiatry PC | Podiatrist | 3310 Highway 62 East, Suite 179, Jeffersonville, IN 47130 | 2017-09-26 |
| 1629592191 | Christie Foot & Ankle, LLC | Podiatrist | 3031 Meridian Meadows Rd, Greenwood, IN 46142-1011 | 2017-07-27 |
| 1154842896 | Major Multispecialty Associates | Podiatrist | 30 W Rampart St Ste 180, Shelbyville, IN 46176-8845 | 2017-07-03 |
| 1336677046 | John Paul Bonvillian | Podiatrist | Major Hospital, 2451 Intelliplex Dr, Shelbyville, IN 46176 | 2017-05-24 |
| 1538693536 | Nicholas Nicholas Lalios | Podiatrist | 7800 Madison St, Merrillville, IN 46410-4615 | 2017-04-17 |
| 1558713354 | Allegiant Podiatry, Inc. | Podiatrist | 515 Silhavy Rd, Apt # 2, Valparaiso, IN 46383-4452 | 2016-07-06 |
| 1275984643 | Jordan Gardner | Podiatrist | 3801 Bellemeade Ave Ste 110, Evansville, IN 47714-0111 | 2016-06-28 |
| 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.