Beacon Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01033081A Issued in IN

Legal business name

BEACON MEDICAL GROUP, INC.

Doing business as

Beacon Medical Group Lakeville

Practice address

601 North Michigan Street
Lakeville, IN 46536

Phone

(574) 784-8244

Fax

(574) 784-8632

NPI assigned

May 17, 2006

Last updated

Aug 29, 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 Costello

Title

VP-Cfo

Phone

(574) 647-3549

Specialties & licenses 1

Addresses

Other names 1

• Beacon Medical Group Lakeville Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 7

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.

• Kenneth Eugene Elek, M.D.

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1912995267
  NPD (past)
• Carolyn Christine Klaus, M.D.

  • Internal Medicine Physician
  • South Bend, IN
  • NPI 1811988561
  NPD (past)
• Keyna Ann Martinez, M.D.

  • Family Medicine Physician
  • Bremen, IN
  • NPI 1013941699
  NPD (past)
• Tamara L Riess, NP

  • Adult Health Nurse Practitioner
  • Elkhart, IN
  • NPI 1144281130
  NPD (past)
• Ellyn Therese Stecker, M.D.

  • Family Medicine Physician
  • Lakeville, IN
  • NPI 1275517351
  NPD (past)
• Maria K Klahre, MD

  • Family Medicine Physician
  • Alma, MI
  • NPI 1134157985
  NPD (past)
• Luzviminda Dulnuan Saidro, M.D.

  • Family Medicine Physician
  • Campo, CA
  • NPI 1750364386
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472428800000",
    "number": "1699727545",
    "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": "601 NORTH MICHIGAN STREET",
            "city": "LAKEVILLE",
            "state": "IN",
            "postal_code": "46536",
            "telephone_number": "574-784-8244",
            "fax_number": "574-784-8632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2016-08-29",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VP-CFO",
        "authorized_official_telephone_number": "574-647-3549"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01033081A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Lakeville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Compass Family Care Co
• Lisa Ann Feitz
• Cynthia Lee Heckman-Davis, M.D.
• Hoosier Taxi Inc (Hoosier Medical Transport)
• Martina Samm, RDN

• Family Medicine Physician in Lakeville, IN
• Providers in Lakeville, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.