Beacon Medical Group, Inc.

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

Legal business name

BEACON MEDICAL GROUP, INC.

Practice address

1753 Fulton St
Elkhart, IN 46514-1927

Phone

(574) 293-9448

Fax

(574) 293-9480

NPI assigned

Oct 10, 2012

Last updated

Oct 12, 2017By 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

Mr. Jeffrey P Costello

Title

Cfo

Phone

(574) 647-3549

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 6

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.

• Edwin Laryea Annan, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Elkhart, IN
  • NPI 1528245040
  NPD
• Nicholas Harold Kerr, DO

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • South Bend, IN
  • NPI 1033470851
  NPD
• Jose Luis Lopez Jr., M.D.

  • Neurology Physician
  • Mishawaka, IN
  • NPI 1336352806
  NPD
• Luke Alfred White, DO

  • Critical Care Medicine (Internal Medicine) Physician
  • South Bend, IN
  • NPI 1528390770
  NPD
• Diego Jose Heredia Vintimilla, M.D.

  • Pulmonary Disease Physician
  • Naples, FL
  • NPI 1831321942
  NPD
• Usman K Qadeer, M.D.

  • Neurology Physician
  • Orland Park, IL
  • NPI 1467728378
  NPD

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507766400000",
    "number": "1295087500",
    "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": "1753 FULTON ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141927",
            "telephone_number": "574-293-9448",
            "fax_number": "574-293-9480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1753 Fulton St",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465141927",
            "country_code": "US",
            "telephone_number": "574-293-9448",
            "fax_number": "574-293-9480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2017-10-12",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFREY",
        "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": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beacon Health Ventures Inc
• Beacon Health Ventures, Inc.
• Beacon Medical Group Inc (Beacon Medical Group Anesthesia Elkhart)
• Beacon Medical Group Inc. (Beacon Medical Group Concord Specialty Clinic)
• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc. (Beacon Medical Group OBGYN River Oaks)
• Beacon Medical Group, Inc. (Beacon Medical Group Advanced Cardiovascular Specialists Riverpointe)
• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc. (Beacon Medical Group-Elkhart East)
• Beacon Medical Group, Inc. (Beacon Medical Group GI and Interventional Radiology)

• Otolaryngology/Facial Plastic Surgery Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; 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.