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Contact Information

BEACON MEDICAL GROUP, INC.
100 NAVARRE PL STE 6600
SOUTH BEND, IN46601-1173
 Phone: 574-647-8800
 Fax: 574-647-8811
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neurological Surgery

207T00000X 02 Physician/General Surgery
 

Clinical Neurophysiology

2084N0600X 86 Physician/Neuropsychiatry
 

Family

363LF0000X 50 Nurse Practitioner
 

Neurology

2084N0400X 13 Physician/Neurology
 

Physician Assistant

363A00000X 97 Physician Assistant
 

Sleep Medicine

2084S0012X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for BEACON MEDICAL GROUP, INC.

NPI # 1861421141
LBN Legal business name BEACON MEDICAL GROUP, INC.
Authorized official JEFFREY COSTELLO - (VP/CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 06/30/2006
Last updated 03/30/2026 - About 2 months ago
Identifiers
IN Medicaid 201003280A
IN Medicaid 201003280B
IN Medicaid 300041458
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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