BEACON MEDICAL GROUP, INC. (NPI# 1821482431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821482431 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Practice Address |
100 Navarre Pl Ste 4470 South Bend IN 46601-1168 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746474230 |
| Practice Fax Number | 5746474235 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2017-10-12 |
| Authorized Official Name | JEFFREY P. COSTELLO (CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | Y |
| Parent Organization Name | BEACON HEALTH SYSTEM, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
Allopathic & Osteopathic Physicians |
| 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 |
100 NAVARRE PL STE 4470 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1168 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386634236 | Paul C Liu | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2005-10-24 |
| 1821443235 | Kari Sower | Nurse Practitioner | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2016-05-04 |
| 1124262522 | Nonyem Onujiogu | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2009-04-29 |
| 1629255880 | Latoya Jeaneen Perry | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2008-01-29 |
| 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 | 207VX0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecologic Oncology |
| An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386634236 | Paul C Liu | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2005-10-24 |
| 1487939732 | Michiana Hematology-oncology P C | Obstetrics & Gynecology | 615 N Michigan St, South Bend, IN 46601-1033 | 2011-10-19 |
| 1629255880 | Latoya Jeaneen Perry | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2008-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215198080 | Emma Caroline Rossi | Obstetrics & Gynecology | 1030 W. Michigan St., Indianapolis, IN 46202 | 2008-06-24 |
| 1639343619 | Nabila Rasool | Obstetrics & Gynecology | 8111 S Emerson Ave # 204, Indianapolis, IN 46237 | 2008-04-21 |
| 1437146081 | John P. Geisler | Obstetrics & Gynecology | 2510 E Dupont Rd Ste 236, Fort Wayne, IN 46825-1603 | 2005-09-29 |
| 1154317675 | James Robert Dunlop | Obstetrics & Gynecology | 8051 S Emerson Ave Ste 400, Indianapolis, IN 46237-8633 | 2005-09-20 |
| 1437153913 | Michael W Method | Obstetrics & Gynecology | 7979 N Shadeland Ave, Ste 310, Indianapolis, IN 46250-2042 | 2005-06-13 |
| 1295141380 | Gynecologic Oncology of Northeast Indiana, LLC | Obstetrics & Gynecology | 1818 Carew St, Suite 250, Fort Wayne, IN 46805-4788 | 2014-07-09 |
| 1053677591 | Sarah Dilley | Obstetrics & Gynecology | 7979 N Shadeland Ave Ste 310, Indianapolis, IN 46250 | 2012-04-10 |
| 1215203559 | Megan Elyse Buechel | Obstetrics & Gynecology | 8402 Harcourt Rd Ste 420, Indianapolis, IN 46260-2053 | 2012-03-30 |
| 1124303466 | Michiana Hematology-oncology P C | Obstetrics & Gynecology | 1205 S Main St, Suite 301, Crown Point, IN 46307-3676 | 2011-10-19 |
| 1679857411 | St Margaret Mercy Healthcare Centers | Obstetrics & Gynecology | 24 Joliet St, Dyer, IN 46311-1705 | 2011-09-28 |
| 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.