NPIMap

Beacon Medical Group, Inc.

Organization Active NPI Family Medicine Physician · Elkhart, IN

NPI 1710329008 · NPPES record last updated Sep 24, 2013

Key facts

NPI
1710329008
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
License
01054569A (IN)
Legal business name
BEACON MEDICAL GROUP, INC.
Practice address
3301 County Road 6 E
Elkhart, IN 46514-7673
Phone
(574) 266-5342
Fax
(574) 266-5847
NPI assigned
Jul 27, 2013
Organization subpart
No

Authorized official

Name
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 7

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

  • Lisa J Felsman, MD Family Medicine Physician · Bristol, IN · NPI 1740501444
    NPD FAMILY MEDICINE
  • Jeffrey S Howe, M.D. Family Medicine Physician · Elkhart, IN · NPI 1750380424
    NPD FAMILY MEDICINE
  • Alejandro Mikelonis, PA-C Physician Assistant · South Bend, IN · NPI 1801300330
    NPD
  • Laura E Munkel, M.D. Family Medicine Physician · Goshen, IN · NPI 1104825223
    NPD FAMILY MEDICINE
  • Jagadeesh Reddy, M.D. Psychiatry Physician · South Bend, IN · NPI 1275705691
    NPD
  • Danielle R. Russo, M.D. Family Medicine Physician · Nappanee, IN · NPI 1346249364
    NPD FAMILY MEDICINE
  • Lindsey K Troyer, NP Family Nurse Practitioner · Elkhart, IN · NPI 1689031700
    NPD

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 01054569A IN Yes

Addresses

Primary practice location

3301 County Road 6 E
Elkhart, IN 46514-7673

Mailing address

3301 County Road 6 E
Elkhart, IN 46514-7673

Other names

  • Med Point Urgent Care Center at CR 6 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 24, 2013.

{
    "created_epoch": "1374883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1710329008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 COUNTY ROAD 6 E",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465147673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 COUNTY ROAD 6 E",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465147673",
            "telephone_number": "574-266-5342",
            "fax_number": "574-266-5847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-27",
        "last_updated": "2013-09-24",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01054569A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Med Point Urgent Care Center at CR 6",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhart, IN

All providers in Elkhart, IN · Family Medicine Physician in Indiana

Sources for this page

Verify at the official NPI Registry.