BEACON MEDICAL GROUP, INC. (NPI# 1699794057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699794057 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP GASTROENTEROLOGY ELKHART |
| Practice Address |
500 Arcade Ave Ste 300 Elkhart IN 46514-2486 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5743897362 |
| Practice Fax Number | 5743895612 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-09-30 |
| 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 |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
06-005017-1 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM BCBS | 000000192830 | 01 |
| IN | 200331910A | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Gastroenterology Elkhart | 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 |
| 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 |
500 ARCADE AVE STE 300 |
| City | ELKHART |
| State | IN |
| Zip Code | 46514-2486 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750589743 | Barbara Jo Ditmer | Physical Medicine & Rehabilitation | 500 Arcade Ave Ste 300, Elkhart, IN 46514-2486 | 2007-07-11 |
| 1689733727 | Christine M Zmyslo | Occupational Therapist | 500 Arcade Ave Ste 300, Elkhart, IN 46514-2486 | 2006-12-06 |
| 1740376847 | Susan H Silberman | Occupational Therapist | 500 Arcade Ave Ste 300, Elkhart, IN 46514-2486 | 2006-10-05 |
| 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 | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| 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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1447253539 | Abuzafar M. Arif | Internal Medicine | 600 East Blvd, Elkhart, IN 46514-2483 | 2005-05-23 |
| 1497797880 | Binoy Ouseph | Internal Medicine | 600 East Blvd, Elkhart, IN 46514-2483 | 2006-06-12 |
| 1326098013 | Mamoon A. Raza | Internal Medicine | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2006-05-11 |
| 1710986492 | Burton Boron | Internal Medicine | 600 East Blvd, Elkhart, IN 46514-2483 | 2005-07-15 |
| 1386647170 | John P. Karagiannis | Internal Medicine | 303 S Nappanee St, Elkhart, IN 46514-2066 | 2005-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710486295 | Gastro Md, LLC | Internal Medicine | 625 Richland Way, Westfield, IN 46074-9054 | 2018-02-09 |
| 1790137115 | Abdinoor Medical LLC | Internal Medicine | 1819 Braemar Dr, Fort Wayne, IN 46814-9364 | 2016-07-09 |
| 1538578018 | Shail Sheth | Internal Medicine | 3903 S 7th St Ste 2f, Terre Haute, IN 47802-5710 | 2014-08-08 |
| 1992113245 | Unity Healthcare, LLC | Internal Medicine | 1345 Unity Pl Ste 110, Lafayette, IN 47905-5768 | 2014-07-31 |
| 1265773113 | Michael Sai Lai Sey | Internal Medicine | 550 N. University Blvd, Suite 4100, Indiana University Hospital, Indianapolis, IN 46202 | 2013-03-01 |
| 1649531062 | Kavish Rohit Patidar | Internal Medicine | 702 Rotary Cir Ste 225, Indianapolis, IN 46202-5133 | 2012-06-01 |
| 1265726673 | Digestive Healthcare Specialists LLC | Internal Medicine | 8865 W 400 N Ste 155, Michigan City, IN 46360-9010 | 2011-06-02 |
| 1033442991 | Dana Charles Moffatt | Internal Medicine | 359 N West St, Apt 284, Indianapolis, IN 46202-4207 | 2009-09-10 |
| 1134356173 | Robert G. Overstreet | Internal Medicine | 348 Bohart Ln, Charlestown, IN 47111-1606 | 2009-06-17 |
| 1003057993 | John Charles Lowe Sr. | Internal Medicine | 10912 300 Yard Dr, Fishers, IN 46037-9306 | 2009-03-23 |
| 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.