Individual provider Active NPI

Kaitlin Marie Castro, PA-C

  • Physician Assistant
  • South Bend, IN
National Provider Identifier
1568345437
Registry record updated Jan 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
610 N Michigan St Ste 400
South Bend, IN 46601-1081
Phone
(574) 647-8120
Fax
(574) 647-8111
NPI assigned
Jul 29, 2025
Last updated
Jan 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

610 N Michigan St Ste 400
South Bend, IN 46601-1081

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-3725

Other practice location 1

610 N Michigan St Ste 306
South Bend, IN 46601-1079
Phone (574) 647-6500

Other practice location 2

3220 Beacon Pkwy Ste 200
Granger, IN 46530-7196
Phone (574) 647-8788

Other identifiers 1

IdentifierTypeStateIssuer
300124413MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251129000329 IN Practitioner - Physician Assistant 6901399898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

610 N Michigan St
400 BMG Adv Cardiology Specialists
South Bend, IN 46601-1081
Phone (574) 647-8120

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Nov 30, 2025 Accepting new patients
Beacon Medical Group, Inc. Physician Assistant CurrentSince Nov 30, 2025 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

3220 Beacon Pkwy
Ste 200
Granger, IN 46530
Phone (574) 647-8788

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

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

610 N Michigan St
Ste 400
South Bend, IN 46601
Phone (574) 204-7333

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768780800000",
    "number": "1568345437",
    "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",
            "telephone_number": "574-647-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N MICHIGAN ST STE 400",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011081",
            "telephone_number": "574-647-8120",
            "fax_number": "574-647-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 N Michigan St Ste 306",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011079",
            "country_code": "US",
            "telephone_number": "574-647-6500",
            "fax_number": "574-647-6518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3220 Beacon Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465307196",
            "country_code": "US",
            "telephone_number": "574-647-8788",
            "fax_number": "574-647-3321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTRO",
        "first_name": "KAITLIN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-29",
        "last_updated": "2026-01-19",
        "certification_date": "2026-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300124413",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.