NPIMap

Organization Active NPI

Beacon Medical Group, Inc.

  • Vascular & Interventional Radiology Physician
  • Granger, IN
National Provider Identifier
1487038360
Registry record updated Oct 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
BEACON MEDICAL GROUP, INC.
Practice address
233 Florence Ave
Granger, IN 46530-8048
Phone
(574) 647-3990
Fax
(574) 647-3995
NPI assigned
Jul 10, 2015
Organization subpart
Yes
Parent organization
BEACON HEALTH SYSTEM, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
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.

View all 26

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN

Medicare enrollment records

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

Tax ID family
Goshen Family (27 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

NPPES NPI Registry

Primary practice location

233 Florence Ave
Granger, IN 46530-8048

Mailing address

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

Other names 1

NPPES NPI Registry
  • Beacon Medical Group Vein Specialists Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 12, 2017.

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507766400000",
    "number": "1487038360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 E NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 FLORENCE AVE",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308048",
            "telephone_number": "574-647-3990",
            "fax_number": "574-647-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEACON HEALTH SYSTEM, INC.",
        "enumeration_date": "2015-07-10",
        "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": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Vein Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granger, IN

Sources for this page

  • 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.