NPIMap

Organization Active NPI

Beacon Orthopaedics & Sports Medicine, LTD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Lebanon, OH
National Provider Identifier
1104442516
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD
Practice address
100 Arrow Springs Blvd Ste 2600
Lebanon, OH 45036-7021
Phone
(513) 354-3700
Fax
(513) 354-7651
NPI assigned
Jun 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy Yuckman
Title
Ceo
Phone
(513) 354-7785

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

100 Arrow Springs Blvd Ste 2600
Lebanon, OH 45036-7021

Mailing address

6480 Harrison Ave Ste 201
Cincinnati, OH 45247-7961
Phone (513) 354-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200731001535 OH DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0345136412 Practice locations: Lebanon, OH

National Provider Directory

National Provider Directory
Tax ID family
Beacon Orthopaedics Sports Medicine LTD47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1104442516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 HARRISON AVE STE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477961",
            "telephone_number": "513-354-3700",
            "fax_number": "513-354-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ARROW SPRINGS BLVD STE 2600",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450367021",
            "telephone_number": "513-354-3700",
            "fax_number": "513-354-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "YUCKMAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "513-354-7785"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.