Beacon Medical Group Inc.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

BEACON MEDICAL GROUP INC.

Doing business as

Beacon Medical Group Concord Specialty Clinic

Practice address

25651 County Road 20
Elkhart, IN 46517-2310

Phone

(574) 524-7128

Fax

(574) 296-6522

NPI assigned

Jul 15, 2014

Last updated

Aug 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey P Costello

Title

Cfo

Phone

(574) 647-3549

Specialties & licenses 1

Addresses

Other names 1

• Beacon Medical Group Concord Specialty Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1679980320",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25651 COUNTY ROAD 20",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465172310",
            "telephone_number": "574-524-7128",
            "fax_number": "574-296-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2016-08-30",
        "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"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Concord Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Beacon Medical Group, Inc. (Beacon Medical Group OBGYN River Oaks)
• Beacon Medical Group, Inc. (Beacon Medical Group Advanced Cardiovascular Specialists Riverpointe)
• Beacon Medical Group, Inc.

• Cardiovascular Disease Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Cardiovascular Disease Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.