Beacon Medical Group, Inc.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

BEACON MEDICAL GROUP, INC.

Doing business as

Beacon Medical Group Neurology
Beacon Medical Group North Central NeuroSurgery Elkhart
Beacon Medical Group North Central NeuroSurgery South Bend1 more in Other names

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

Last updated

Mar 30, 2026By 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. Jeffrey P Costello

Title

VP/Cfo

Phone

(574) 647-3549

Specialties & licenses 6

Addresses

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 fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 20

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.

• Amanda Ahmed

  • Physician Assistant
  • South Bend, IN
  • NPI 1578384673
  NPD
• Kiesha Anderson, D.O.

  • Clinical Neurophysiology Physician
  • Mishawaka, IN
  • NPI 1720439680

  Neurology

  NPD
• Andrew R Berkson, DO

  • Physical Medicine & Rehabilitation Physician
  • South Bend, IN
  • NPI 1255304010
  NPD
• Tonia L Collins, NP

  • Family Nurse Practitioner
  • Elkhart, IN
  • NPI 1437265337
  NPD
• Gina M. Connolly, NP

  • Adult Health Nurse Practitioner
  • Chesterton, IN
  • NPI 1023364262
  NPD
• Amy Hertzler Deel, NP

  • Family Nurse Practitioner
  • South Bend, IN
  • NPI 1730547738
  NPD
• Richard David Fessler, MD, PHD

  • Neurological Surgery Physician
  • South Bend, IN
  • NPI 1134641038
  NPD
• Daniel H Fulkerson, M.D.

  • Neurological Surgery Physician
  • South Bend, IN
  • NPI 1386802387
  NPD
• Tamara Ann Fuller, FNP-BC

  • Family Nurse Practitioner
  • South Bend, IN
  • NPI 1891420154
  NPD
• Wei Xia Huff, M.D., PH.D.

  • Neurological Surgery Physician
  • South Bend, IN
  • NPI 1245644574
  NPD
• Sally Elizabeth Hull, NP

  • Family Nurse Practitioner
  • South Bend, IN
  • NPI 1437454808
  NPD
• Kyle Moser, PA-C

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1841695590
  NPD

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": "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"
        },
        {
            "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"
        }
    ],
    "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": [],
    "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"
        }
    ]
}

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• Beacon Medical Group, Inc. (Beacon Medical Group Pediatric Hematology Oncology)
• Beacon Specialty Surgery Center, LLC
• Evan Beakas

• Neurological Surgery Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Neurological Surgery Physician in Indiana

• 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.