NPIMap

Organization Active NPI

Beacon Medical Group, Inc.

Doing business as Beacon Medical Group GI and Interventional Radiology

  • Gastroenterology Physician
  • Elkhart, IN
National Provider Identifier
1699794057
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
06-005017-1 Issued in IN
Legal business name
BEACON MEDICAL GROUP, INC.
Doing business as
Beacon Medical Group GI and Interventional Radiology
Beacon Medical Group Gastroenterology South Bend
Beacon Medical Group Urology Elkhart1 more in Other names
Practice address
500 Arcade Ave Ste 300
Elkhart, IN 46514-2486
Phone
(574) 389-7362
Fax
(574) 389-5612
NPI assigned
Jul 18, 2006
Last updated
Jun 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

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

Authorized official

Name
Mr. Jeffrey P Costello
Title
Cfo
Phone
(574) 647-3549

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 06-005017-1 IN Primary
Vascular & Interventional Radiology Physician 2085R0204X NU
Urology Physician 208800000X NU

Addresses

Primary practice location

500 Arcade Ave Ste 300
Elkhart, IN 46514-2486

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-1610

Other practice location 1

100 Navarre Pl Ste 4400
South Bend, IN 46601-1100
Phone (574) 544-5580

Other practice location 2

1302 College Ave Ste 2
Goshen, IN 46526-4939
Phone (574) 206-0380

Other practice location 3

105 N Nappanee St
Elkhart, IN 46514-1957
Phone (574) 206-0305

Other practice location 4

1506 Osolo Rd Ste A
Elkhart, IN 46514-4122
Phone (574) 295-1131

Other identifiers 4

IdentifierTypeStateIssuer
300054801MedicaidIN
300098369MedicaidIN
300042826MedicaidIN
300098524MedicaidIN

Other names 4

  • Beacon Medical Group GI and Interventional Radiology Doing business as
  • Beacon Medical Group Gastroenterology South Bend Doing business as
  • Beacon Medical Group Urology Elkhart Doing business as
  • Beacon Medical Group Urology Goshen Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2315648Beacon Medical Group Urology Goshen1302 College Ave, Ste 2, Goshen, IN 46526Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Beacon Medical Group Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

1506 Osolo Rd
#A
Elkhart, IN 46514
Phone (574) 295-1131

3301 County Road 6 E
Elkhart, IN 46514
Phone (574) 264-9635

500 Arcade Ave
Ste 300
Elkhart, IN 46514
Phone (574) 296-9100

100 Navarre Pl
Ste 4400
South Bend, IN 46601
Phone (574) 647-2501

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1699794057",
    "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": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 300",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142486",
            "telephone_number": "574-389-7362",
            "fax_number": "574-389-5612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Navarre Pl Ste 4400",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011100",
            "country_code": "US",
            "telephone_number": "574-544-5580",
            "fax_number": "574-544-5579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1302 College Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465264939",
            "country_code": "US",
            "telephone_number": "574-206-0380",
            "fax_number": "574-206-0389",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 N Nappanee St",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465141957",
            "country_code": "US",
            "telephone_number": "574-206-0305",
            "fax_number": "574-206-0310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1506 Osolo Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465144122",
            "country_code": "US",
            "telephone_number": "574-295-1131",
            "fax_number": "574-293-8641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "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": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "06-005017-1",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300054801",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300098369",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300042826",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300098524",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group GI and Interventional Radiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Gastroenterology South Bend",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Urology Elkhart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Urology Goshen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (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.