NPIMap

Organization Active NPI

Beacon Allegan Inc

Doing business as Beacon Allegan

  • Rural Health Clinic/Center
  • Gobles, MI
National Provider Identifier
1306323043
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 ALLEGAN INC
Doing business as
Beacon Allegan
Gobles Medical Clinic
Practice address
406 N State St
Gobles, MI 49055-9717
Phone
(269) 628-2196
Fax
(269) 628-2363
NPI assigned
Jul 25, 2018
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 NU Primary

Addresses

Primary practice location

406 N State St
Gobles, MI 49055-9717

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
1306323043MedicaidMI

Other names 2

  • Beacon Allegan Doing business as
  • Gobles Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100823000998 MI Part B Supplier - Clinic/Group Practice 5092750356 Receives reassigned benefits from 50 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Otsego, MI; Gobles, MI; Fennville, MI; Allegan, MI
O20180919000148 MI Part A Provider - Rural Health Clinic 5092750356 Practice locations: Gobles, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306323043. Details of each certification follow.

Rural health clinic certification: CCN 238710

Legal name
ASCENSION BORGESS ALLEGAN HOSPITAL
Doing business as
BEACON ALLEGAN GOBLES CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 18, 2018
Last certification
Jun 2, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
406 N State St
Gobles, MI 49055-9717
Related CCNs
231328

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Allegan General Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Irene Maffetone Individual W-2 Managing EmployeeSenior Contracting Specialist Jul 1, 2025
Amber L Paggeot Individual W-2 Managing EmployeeDirector of Practice Transformation Oct 15, 2020
Jeffrey P Costello Individual Corporate DirectorCfo Jul 1, 2025
W-2 Managing Employee Jul 1, 2025
Ascension Michigan Organization, Troy, MI Non-profit, Chain home office Operational/Managerial Control Jan 1, 2022

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791504000000",
    "number": "1306323043",
    "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": "406 N STATE ST",
            "city": "GOBLES",
            "state": "MI",
            "postal_code": "490559717",
            "telephone_number": "269-628-2196",
            "fax_number": "269-628-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON ALLEGAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306323043",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Allegan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gobles Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gobles, MI

Sources for this page

Verify at the official NPI Registry.