Beacon Medical Group Inc

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

01027434A Issued in IN

Legal business name

BEACON MEDICAL GROUP INC

Doing business as

Women's Reproductive Medicine

Practice address

100 Navarre PL
Suite 4470
South Bend, IN 46601-1156

Phone

(574) 647-4230

NPI assigned

May 18, 2006

Last updated

Aug 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Costello

Title

VP-Cfo

Phone

(574) 647-3549

Specialties & licenses 1

Addresses

Other names 1

• Women's Reproductive Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1124071246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL",
            "address_2": "SUITE 4470",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011156",
            "telephone_number": "574-647-4230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-08-30",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VP-CFO",
        "authorized_official_telephone_number": "574-647-3549"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01027434A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Women's Reproductive Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc. (Beacon Medical Group- Trauma and Surgical Services)

• Obstetrics & Gynecology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Obstetrics & Gynecology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.