Beacon Medical Group, Inc.
Organization
Active NPI
Family Medicine Physician · Bristol, IN
NPI 1447285697 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1447285697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 06-005017-1 (IN)
- Legal business name
- BEACON MEDICAL GROUP, INC.
- Practice address
- 306 E Vistula
Bristol, IN 46507-9489
- Phone
- (574) 848-4427
- Fax
- (574) 848-4592
- NPI assigned
- Jul 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey P Costello
- Title
- Cfo
- Phone
- (574) 647-3549
Corporate family (same tax ID) 26
Organizations that report the same tax identification number in the National Provider Directory.
-
Beacon Medical Group Inc Anesthesiology Physician · Elkhart, IN · NPI 1437803285
-
Beacon Medical Group, Inc. Family Medicine Physician · Mishawaka, IN · NPI 1033161617
-
Beacon Medical Group, Inc. Internal Medicine Physician · Elkhart, IN · NPI 1114262078
-
Beacon Medical Group, Inc. Family Medicine Physician · Middlebury, IN · NPI 1114363835
-
Beacon Medical Group, Inc. Nephrology Physician · South Bend, IN · NPI 1124423546
-
Beacon Medical Group, Inc. Family Medicine Physician · Wakarusa, IN · NPI 1184641706
-
Beacon Medical Group, Inc. Family Medicine Physician · Mishawaka, IN · NPI 1275550899
-
Beacon Medical Group, Inc. Family Medicine Physician · Goshen, IN · NPI 1306863915
-
Beacon Medical Group, Inc. Obstetrics & Gynecology Physician · Elkhart, IN · NPI 1316073372
-
Beacon Medical Group, Inc. Family Medicine Physician · Nappanee, IN · NPI 1457378069
-
Beacon Medical Group, Inc. Pediatric Critical Care Medicine Physician · South Bend, IN · NPI 1467408237
-
Beacon Medical Group, Inc. Vascular & Interventional Radiology Physician · Granger, IN · NPI 1487038360
-
Beacon Medical Group, Inc. Advanced Practice Midwife · South Bend, IN · NPI 1578862181
-
Beacon Medical Group, Inc. Psychiatry Physician · South Bend, IN · NPI 1629376645
-
Beacon Medical Group, Inc. Family Medicine Physician · Goshen, IN · NPI 1689691297
-
Beacon Medical Group, Inc. Gastroenterology Physician · Elkhart, IN · NPI 1699794057
-
Beacon Medical Group, Inc. Cardiovascular Disease Physician · Elkhart, IN · NPI 1700187457
-
Beacon Medical Group, Inc. Family Medicine Physician · Elkhart, IN · NPI 1710329008
-
Beacon Medical Group, Inc. Maternal & Fetal Medicine Physician · South Bend, IN · NPI 1710939608
-
Beacon Medical Group, Inc. Pulmonary Disease Physician · Elkhart, IN · NPI 1770954992
-
Beacon Medical Group, Inc. Aerospace Medicine Physician · South Bend, IN · NPI 1780856724
-
Beacon Medical Group, Inc. Cardiovascular Disease Physician · South Bend, IN · NPI 1780859157
-
Beacon Medical Group, Inc. Pediatrics Physician · Elkhart, IN · NPI 1861816761
-
Beacon Medical Group, Inc. Sleep Medicine (Internal Medicine) Physician · Elkhart, IN · NPI 1881925188
-
Beacon Medical Group, Inc. Vascular & Interventional Radiology Physician · South Bend, IN · NPI 1932468352
View all 26
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
Rebecca Crimmins Family Nurse Practitioner · Nappanee, IN · NPI 1003655572
-
Kamran Javaid, M.D.
Pulmonary Disease Physician · Elkhart, IN · NPI 1306030648
-
Gabriel Lewis Certified Registered Nurse Anesthetist · Elkhart, IN · NPI 1093316176
-
Angela Marie Wright, PA
Physician Assistant · Mishawaka, IN · NPI 1508013418
Laboratory certificates & supplier records
Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|
| 15D0712697 | Beacon Medical Group Bristol
306 E Vistula St, Bristol, IN 46507 | Certificate of waiver | Feb 19, 2027 |
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
- Tax ID family
- Goshen Family (27 organizations share this tax ID)
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP |
207Q00000X |
06-005017-1 |
IN |
Yes |
Addresses
Primary practice location
306 E Vistula
Bristol, IN 46507-9489
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 000000110755 | Other | IN | BCBS REMIT |
| 100114000B | Medicaid | IN | |
Other names
- Beacon Medical Group Bristol Doing business as
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.
Verify at the official NPI Registry.