Beacon Medical Group, Inc.
Organization Active NPI Endocrinology, Diabetes & Metabolism Physician · Granger, IN
NPI 1306899554 · NPPES record last updated Dec 9, 2019
Key facts
- NPI
- 1306899554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician 207RE0101X
- Legal business name
- BEACON MEDICAL GROUP, INC.
- Practice address
- 6913 N Main St Ste 100
Granger, IN 46530 - Phone
- (574) 647-6400
- Fax
- (574) 647-2951
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Jeffrey Costello
- Title
- VP-Cfo
- Phone
- (574) 647-3549
Practitioners 1
-
Andrew Clark McAfee, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000657 | IN | Part B Supplier - Clinic/Group Practice | 1254243306 |
Receives reassigned benefits from 737 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | Yes |
Addresses
Primary practice location
6913 N Main St Ste 100
Granger, IN 46530
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100224050D | Medicaid | IN |
Other names
- Beacon Medical Group Specialists Main Suite 100
Other providers in Granger, IN
- Beacon Health, LLC
- Beacon Health, LLC
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Mason I Beall
- Beds by George, Inc.
- John Jacob Bell
All providers in Granger, IN · Endocrinology, Diabetes & Metabolism Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.