NPIMap

Organization Active NPI

Beacon Dowagiac Inc

Doing business as Beacon Dowagiac

  • Rural Health Clinic/Center
  • Dowagiac, MI
National Provider Identifier
1194717504
Registry record updated Oct 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BEACON DOWAGIAC INC
Doing business as
Beacon Dowagiac
Borgess Lee Medical Group
Practice address
420 W High St
Dowagiac, MI 49047-1943
Phone
(269) 783-3052
NPI assigned
Aug 22, 2005
Last updated
Oct 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2026

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

Authorized official

Name
Irene Maffetone
Title
Manager Contracting and Payor Relat
Phone
(574) 647-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MI Primary

Addresses

Primary practice location

420 W High St
Dowagiac, MI 49047-1943

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other practice location 1

520 Main St Ste A
Dowagiac, MI 49047-1762
Phone (269) 783-3052

Other names 2

  • Beacon Dowagiac Doing business as
  • Borgess Lee Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000763 MI Part B Supplier - Clinic/Group Practice 7719881002 Receives reassigned benefits from 45 practitioners
1 other NPI on this enrollment
Practice locations: Dowagiac, MI
O20080304000655 MI Part A Provider - Rural Health Clinic 7719881002 Practice locations: Dowagiac, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194717504. Details of each certification follow.

Rural health clinic certification: CCN 238544

Legal name
ASCENSION BORGESS LEE HOSPITAL
Doing business as
BEACON DOWAGIAC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 26, 1997
Last certification
Jun 17, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
420 W High St
Dowagiac, MI 49047-1943
Related CCNs
231315

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paul Hodge Individual Corporate OfficerBoard Member Jul 1, 2025
Irene Maffetone Individual W-2 Managing EmployeeSenior Contracting Specialist Jul 1, 2025
James H Connell Individual Corporate OfficerBoard Member Jul 1, 2025
Beacon Health System Inc Organization, South Bend, IN Corporation, Non-profit, Chain home office Operational/Managerial Control Jul 1, 2025
Jeffrey P Costello Individual Corporate OfficerCfo Jul 1, 2025
W-2 Managing EmployeeCfo Jul 1, 2025
Operational/Managerial ControlCfo Jul 1, 2025 100%
Mary Gondeck Individual Corporate OfficerBoard Member Jul 1, 2025
Jason E Burchardt Individual Corporate OfficerBoard Member Jul 1, 2025
Thelma Susan Pozo Individual Corporate OfficerBoard Member Jul 1, 2025
Charles Burling Individual Corporate OfficerBoard Member Jul 1, 2025
James Bailey Babel Individual Corporate OfficerBoard Member Jul 1, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 21

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 21

Practitioners & affiliated clinicians

Practitioners 50

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.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791504000000",
    "number": "1194717504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "fax_number": "574-647-1821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W HIGH ST",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490471943",
            "telephone_number": "269-783-3052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Main St Ste A",
            "address_purpose": "LOCATION",
            "city": "Dowagiac",
            "state": "MI",
            "postal_code": "490471762",
            "country_code": "US",
            "telephone_number": "269-783-3052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON DOWAGIAC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2026-10-09",
        "certification_date": "2026-10-09",
        "status": "A",
        "authorized_official_last_name": "MAFFETONE",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "MANAGER CONTRACTING AND PAYOR RELAT",
        "authorized_official_telephone_number": "574-647-1040"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Dowagiac",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Borgess Lee Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dowagiac, MI

Sources for this page

Verify at the official NPI Registry.