BEACON MEDICAL GROUP, INC. (NPI# 1881925188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881925188 |
| Entity Type | Organization |
| Organization Name | BEACON MEDICAL GROUP, INC. |
| Other Organization Name | BEACON MEDICAL GROUP SLEEP MEDICINE ELKHART EAST |
| Practice Address |
3301 County Road 6 E Elkhart IN 46514-7673 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5742649635 |
| Practice Fax Number | 5742620398 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2016-10-27 |
| 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 | 261QS1200X |
Clinic/Center Specialization: Sleep Disorder Diagnostic |
10-005017-1 | IN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200977370 | 05 |
| Other Name | Type Code |
|---|---|
| Beacon Medical Group Sleep Medicine Elkhart East | 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 |
3301 COUNTY ROAD 6 E |
| City | ELKHART |
| State | IN |
| Zip Code | 46514-7673 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750380424 | Jeffrey S Howe | Family Medicine | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2005-07-15 |
| 1679954655 | John Russell Griggs | Family Medicine | 3301 County Road 6 E, Elkhart, IN 46514 | 2015-06-15 |
| 1104225739 | Carrie Daniels | Nurse Practitioner | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2014-08-20 |
| 1891194981 | Tabitha M. Pollard | Nurse Practitioner | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2014-08-14 |
| 1710329008 | Beacon Medical Group, Inc. | Family Medicine | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2013-07-27 |
| 1184966681 | Anna N Matulewicz | Nurse Practitioner | 3301 County Road 6 E, Elkhart, IN 46514 | 2013-03-22 |
| 1164781480 | Saadia Qasim | Family Medicine | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2012-05-07 |
| 1164759106 | Rose Paul | Family Medicine | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2009-11-12 |
| 1316270523 | Tamara L Pinto | Nurse Practitioner | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2009-09-08 |
| 1285758250 | Janet E Badding | Family Medicine | 3301 County Road 6 E, Elkhart, IN 46514-7673 | 2007-03-16 |
| Find all providers in the same location | ||||
| 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 | 261QS1200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Sleep Disorder Diagnostic |
| Definition to come... |
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| 1598144040 | Layous LLC | Clinic/Center | 1650 45th Ave, Suite E/ 2a, Munster, IN 46321-3962 | 2015-05-29 |
| 1417382250 | Deaconess Hospital, Inc | Clinic/Center | 7307 E Columbia St, Ste 200, Evansville, IN 47715-9141 | 2013-09-12 |
| 1205260528 | Deaconess Clinic, Inc | Clinic/Center | 7307 E Columbia St, Ste 200, Evansville, IN 47715-9141 | 2013-08-22 |
| 1013264845 | Sleep Health Center, Inc | Clinic/Center | 8733 W 400 N, Michigan City, IN 46360-9330 | 2012-08-10 |
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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.