Beacon Medical Group, Inc.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

Legal business name

BEACON MEDICAL GROUP, INC.

Doing business as

Beacon Medical Group Cardio Thoracic Surgery Elkhart

Practice address

500 Arcade Ave Ste 230
Elkhart, IN 46514-2485

Phone

(574) 522-6565

Fax

(574) 522-5572

NPI assigned

May 6, 2011

Last updated

Apr 28, 2023By 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

Mr. Jeff P Costello

Title

Cfo

Phone

(574) 647-3549

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beacon Medical Group Cardio Thoracic Surgery Elkhart Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 3

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.

• Tommi Andersen

  • Physician Assistant
  • Elkhart, IN
  • NPI 1407534712
  NPD
• Walid Khabbaz, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • South Bend, IN
  • NPI 1669563342
  NPD
• Daniel Joseph Weber, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • South Bend, IN
  • NPI 1942520762
  NPD

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

{
    "created_epoch": "1304640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1841582087",
    "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": "500 ARCADE AVE STE 230",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142485",
            "telephone_number": "574-522-6565",
            "fax_number": "574-522-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-06",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFF",
        "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": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201022950A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Cardio Thoracic Surgery Elkhart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beacon Medical Group, Inc. (Beacon Medical Group GI and Interventional Radiology)
• Beacon Medical Group, Inc. (Elkhart Cardiology)
• Beacon Medical Group, Inc. (Med Point Urgent Care Center at CR 6)
• Beacon Medical Group, Inc. (Beacon Medical Group Pulmonology and General Surgery)
• Beacon Medical Group, Inc. (Beacon Bone and Joint Specialists)
• Beacon Medical Group, Inc. (Beacon Medical Group Pediatrics Bristol Street)
• Beacon Medical Group, Inc. (Beacon Medical Group Sleep Medicine)
• Beacon Occupational Health, LLC
• Carol Joann Beathea, PHD LCSW MSW
• David A Beatty, MD

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) 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.