Beacon Medical Group, Inc.

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

Legal business name

BEACON MEDICAL GROUP, INC.

Doing business as

BMG Women's Surgical GYN/Onc @ MRCC

Practice address

100 Navarre PL Ste 4470
South Bend, IN 46601-1168

Phone

(574) 647-4230

Fax

(574) 647-4235

NPI assigned

Mar 20, 2015

Last updated

Apr 28, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

BEACON HEALTH SYSTEM, INC.As reported in NPPES

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 identifiers 1

Other names 1

• BMG Women's Surgical GYN/Onc @ MRCC Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 6

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.

• Margaret Eileen Lammering

  • Physician Assistant
  • Elkhart, IN
  • NPI 1801578307
  NPD
• Latoya Jeaneen Perry, M.D.

  • Gynecologic Oncology Physician
  • South Bend, IN
  • NPI 1629255880
  NPD
• Nicole Rogers

  • Physician Assistant
  • Elkhart, IN
  • NPI 1457183691
  NPD
• Carrie Y Yuan, PA

  • Physician Assistant
  • South Bend, IN
  • NPI 1891463527
  NPD
• Julia A Chapman, MD

  • Gynecologic Oncology Physician
  • Syracuse, NY
  • NPI 1477579548
  NPD
• Amanda M Jackson, M.D.

  • Gynecologic Oncology Physician
  • Tripler AMC, HI
  • NPI 1124466438
  NPD

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1821482431",
    "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",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 4470",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011168",
            "telephone_number": "574-647-4230",
            "fax_number": "574-647-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEACON HEALTH SYSTEM, INC.",
        "enumeration_date": "2015-03-20",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "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": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201285860A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMG Women's Surgical GYN/Onc @ MRCC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beacon Medical Group, Inc. (Beacon Medical Group Behavioral Health South Bend)
• Beacon Medical Group, Inc. (Beacon Medical Group Maternal Fetal Medicine South Bend)
• Beacon Medical Group, Inc. (Beacon Medical Group Oncology Elkhart)
• Beacon Medical Group, Inc. (Beacon Medical Group Occupational Health South Bend)
• Beacon Medical Group, Inc. (Beacon Medical Group Advanced Cardiology Specialists South Bend)
• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc. (Beacon Medical Group Neurology)
• Beacon Medical Group, Inc. (Beacon Medical Group Cardiothoracic Surgery South Bend)
• Beacon Medical Group, Inc. (Beacon Medical Group Vascular Interventional Radiology)
• Beacon Medical Group, Inc. (Beacon Medical Group Pediatric Hematology Oncology)

• Gynecologic Oncology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Gynecologic Oncology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; 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.