NPIMap

Organization Active NPI

Beacon Medical Group Inc

Doing business as Beacon Medical Group Anesthesia Elkhart

  • Anesthesiology Physician
  • Elkhart, IN
National Provider Identifier
1437803285
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
BEACON MEDICAL GROUP INC
Doing business as
Beacon Medical Group Anesthesia Elkhart
Practice address
600 East Blvd
Elkhart, IN 46514-2483
Phone
(574) 524-8130
Fax
(574) 524-8138
NPI assigned
Feb 10, 2022
Last updated
Oct 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Authorized official

Name
Irene Maffetone
Title
Contracting Specialist
Phone
(574) 647-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

600 East Blvd
Elkhart, IN 46514-2483

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 1

IdentifierTypeStateIssuer
300060722MedicaidIN

Other names 1

  • Beacon Medical Group Anesthesia Elkhart Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory
Tax ID family
Beacon Medical Group Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations (25 of 34)

1215 Lawn Ave
Ste 120
Elkhart, IN 46514
Phone (574) 523-2733

1506 Osolo Rd
Elkhart, IN 46514
Phone (574) 206-0305

303 S Nappanee St
Ste A
Elkhart, IN 46514
Phone (574) 296-3338

3900 E Bristol St
Elkhart, IN 46514
Phone (574) 970-0004

500 Arcade Ave
#500
Elkhart, IN 46514

500 Arcade Ave
Ste 400
Elkhart, IN 46514
Phone (574) 522-2284

600 East Blvd
Fl 4
Elkhart, IN 46514
Phone (574) 389-7393

724 W Bristol St
Ste G
Elkhart, IN 46514
Phone (219) 266-6050

2120 Rieth Blvd
Ste 200
Goshen, IN 46526
Phone (574) 262-0313

2240 Karisa Dr
Ste 1
Goshen, IN 46526
Phone (574) 534-6757

3221 Beacon Pkwy
Ste B
Granger, IN 46530
Phone (574) 647-1700

6901 N Main St
Ste 102
Granger, IN 46530
Phone (574) 647-4500

10617 E Washington St
Indianapolis, IN 46229
Phone (317) 895-0065

202 Lincolnway E
Ste 201
Mishawaka, IN 46544
Phone (574) 584-2812

301 E Day Rd
Ste 200
Mishawaka, IN 46545
Phone (574) 204-7252

5314 Lincolnway E
Mishawaka, IN 46544
Phone (574) 256-9032

2505 N Oak Dr
Plymouth, IN 46563
Phone (219) 669-7564

100 Navarre Pl
Ste 4470
South Bend, IN 46601
Phone (574) 647-1300

100 Navarre Pl
Ste 5550
South Bend, IN 46601
Phone (574) 234-5123

111 W Jefferson Blvd
Ste 100
South Bend, IN 46601
Phone (574) 647-1669

1815 E Ireland Rd
Ste B
South Bend, IN 46614
Phone (574) 647-5790

2015 W Western Ave
Ste 124
South Bend, IN 46619
Phone (574) 232-4234

360 N Notre Dame Ave
South Bend, IN 46617
Phone (574) 245-4979

420 N Niles Ave
#3
South Bend, IN 46617
Phone (574) 520-6228

610 N Michigan St
Ste 306
South Bend, IN 46601
Phone (574) 647-6500

Practitioners & affiliated clinicians

Practitioners 716

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 716

NPI Registry JSON

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1437803285",
    "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": "600 EAST BLVD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142483",
            "telephone_number": "574-524-8130",
            "fax_number": "574-524-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-10",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "MAFFETONE",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "CONTRACTING SPECIALIST",
        "authorized_official_telephone_number": "574-647-1040"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300060722",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Anesthesia Elkhart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Anesthesia Elkhart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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.