Beacon Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

06-005017-1 Issued in IN

Legal business name

BEACON MEDICAL GROUP, INC.

Practice address

27082 W Main Street
Edwardsburg, MI 49112-9334

Phone

(269) 663-8288

Fax

(269) 663-2426

NPI assigned

Jul 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jeff P Costello

Title

Cfo

Phone

(574) 647-3549

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Beacon Medical Group Edwardsburg Doing business as

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1205852365",
    "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",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27082 W MAIN STREET",
            "city": "EDWARDSBURG",
            "state": "MI",
            "postal_code": "491129334",
            "telephone_number": "269-663-8288",
            "fax_number": "269-663-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-05-03",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-647-3549",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "06-005017-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080A410090",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100220310A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Edwardsburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Edwardsburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Advanced Practice Primary Care Staff Associates
• All About You Homecare
• Shanna Anthony
• Catherine Ann Bazata, OTR
• Beacon Health Ventures Michigan, Inc.
• Byron Counseling LLC
• Mary Rebecca Casteel
• Clear Choice Chiropractic of Edwardsburg, P.C.
• George Erving Drake, MD
• Luke Eichorn, FNP-BC

• Family Medicine Physician in Edwardsburg, MI
• Providers in Edwardsburg, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.