BEACON MEDICAL GROUP, INC. (NPI# 1578515151) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578515151 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP SPORTS MEDICINE SOUTH BEND |
| Practice Address |
111 W Jefferson Blvd Suite 100 South Bend IN 46601-1994 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746471669 |
| Practice Fax Number | 5742396461 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-08-30 |
| 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 | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
01049328A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200302560A | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Sports Medicine South Bend | 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 |
111 W JEFFERSON BLVD SUITE 100 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1994 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629075957 | Linda A Mansfield | Family Medicine | 111 W Jefferson Blvd, Suite 100, South Bend, IN 46601-1994 | 2005-07-01 |
| 1912521378 | Andrew John Findley | Physical Therapist | 111 W Jefferson Blvd, South Bend, IN 46601-1994 | 2020-06-02 |
| 1346711652 | Jennifer Cunningham | Physical Therapist | 111 W Jefferson Blvd, South Bend, IN 46601-1994 | 2018-12-13 |
| 1730677295 | Katelyn Patberg | Specialist/Technologist | 111 W Jefferson Blvd, South Bend, IN 46601-1994 | 2018-04-30 |
| 1578722450 | Paul Adam Enright | Acupuncturist | 111 W Jefferson Blvd, Suite 100, South Bend, IN 46601-1994 | 2008-06-05 |
| 1275712085 | Kara G Werner | Specialist/Technologist | 111 W Jefferson Blvd, Suite 100, South Bend, IN 46601-1994 | 2007-10-29 |
| 1609063908 | Praveen Putlur | Physical Therapist | 111 W Jefferson Blvd, Suite 100, South Bend, IN 46601-1994 | 2007-10-01 |
| 1528277951 | Freya L Burket | Social Worker | 111 W Jefferson Blvd, South Bend, IN 46601-1994 | 2007-05-22 |
| 1952455537 | Jennifer Ann Bodensteiner | Specialist | 111 W Jefferson Blvd, Suite 100, South Bend, IN 46601-1994 | 2007-01-22 |
| 1093726713 | Jennifer A Brake | Family Medicine | 111 W Jefferson Blvd, Ste 100, South Bend, IN 46601-1994 | 2006-08-10 |
| Find all providers in the same location | ||||
| 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 | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://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 Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700231313 | Heather Saffel | Family Medicine | 111 W Jefferson Blvd Ste 100, South Bend, IN 46601-1993 | 2016-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962061135 | Central Indiana Orthopedics, PC | Family Medicine | 14300 E 138th Bldg B, Fishers, IN 46037-0087 | 2019-06-11 |
| 1104326909 | Orthopaedic Associates, Inc. | Family Medicine | 4011 Gateway Blvd Ste 100, Newburgh, IN 47630-8947 | 2018-02-19 |
| 1922477686 | Orthopaedic Associates, Inc. | Family Medicine | 5828 Pearl Dr, Evansville, IN 47712-8116 | 2015-09-23 |
| 1295137925 | Ball State University | Family Medicine | Hp 260, Muncie, IN 47306-0001 | 2014-09-25 |
| 1992118822 | Zachary Conner Ritchie | Family Medicine | 301 Satori Pkwy Ste 120, Avon, IN 46123-6407 | 2014-06-09 |
| 1740692078 | Joel Jaeger | Family Medicine | 275 W Bassett Rd Ste 3, Shelbyville, IN 46176-8575 | 2014-05-21 |
| 1457652992 | Martha Ann Taylor | Family Medicine | 105 Hendron Hills Dr, Vincennes, IN 47591-3638 | 2010-11-16 |
| 1649598707 | Rajih Y Haddawi | Family Medicine | 2631 S Atlee St, Bloomington, IN 47401-4536 | 2010-05-12 |
| 1538300561 | Michael Robert Messmer | Family Medicine | 3221 Beacon Parkway, Granger, IN 46530 | 2009-03-21 |
| 1558551382 | Jerry Edward Blythe | Family Medicine | 8045 Broadway St, Indianapolis, IN 46240-2502 | 2007-07-27 |
| 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.