NPIMap

Organization Active NPI

Beacon Medical Group, Inc.

  • Neurological Surgery Physician
  • South Bend, IN
National Provider Identifier
1861421141
Registry record updated Mar 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
BEACON MEDICAL GROUP, INC.
Practice address
100 Navarre PL Ste 6600
South Bend, IN 46601-1173
Phone
(574) 647-8800
Fax
(574) 647-8811
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2026

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

Authorized official

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Clinical Neurophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0600X
Sleep Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084S0012X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

100 Navarre PL Ste 6600
South Bend, IN 46601-1173

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other practice location 1

100 Navarre Pl Ste 4400
South Bend, IN 46601-1100
Phone (574) 647-2501

Other practice location 2

500 Arcade Ave Ste 200
Elkhart, IN 46514-2485
Phone (574) 294-8404

Other practice location 3

5314 Lincolnway E
Mishawaka, IN 46544-4249
Phone (574) 647-8542

Other practice location 4

6913 N Main St Ste 100
Granger, IN 46530-8039
Phone (574) 647-8542

Other identifiers 3

IdentifierTypeStateIssuer
300041458MedicaidIN
201003280BMedicaidIN
201003280AMedicaidIN

Other names 4

  • Beacon Medical Group Neurology Doing business as
  • Beacon Medical Group North Central NeuroSurgery Elkhart Doing business as
  • Beacon Medical Group North Central NeuroSurgery South Bend Doing business as
  • Beacon Medical Group Specialists Navarre 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

National Provider Directory

National Provider Directory

Locations

500 Arcade Ave
Ste 110
Elkhart, IN 46514
Phone (574) 232-7227

3245 Health Dr
Granger, IN 46530

5314 Lincolnway E
Mishawaka, IN 46544
Phone (574) 256-9032

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774828800000",
    "number": "1861421141",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 6600",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011173",
            "telephone_number": "574-647-8800",
            "fax_number": "574-647-8811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Navarre Pl Ste 4400",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011100",
            "country_code": "US",
            "telephone_number": "574-647-2501",
            "fax_number": "574-647-2506",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Arcade Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142485",
            "country_code": "US",
            "telephone_number": "574-294-8404",
            "fax_number": "574-523-1642",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5314 Lincolnway E",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465444249",
            "country_code": "US",
            "telephone_number": "574-647-8542",
            "fax_number": "574-647-8549",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6913 N Main St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308039",
            "country_code": "US",
            "telephone_number": "574-647-8542",
            "fax_number": "574-647-8549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "574-647-3549",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300041458",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201003280B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201003280A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Neurology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group North Central NeuroSurgery Elkhart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group North Central NeuroSurgery South Bend",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Specialists Navarre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; 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.