Beacon Medical Group, Inc.

Primary specialty

Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X

Legal business name

BEACON MEDICAL GROUP, INC.

Practice address

525 W Bristol St
Elkhart, IN 46514-2964

Phone

(574) 262-0239

Fax

(574) 262-8391

NPI assigned

Jan 26, 2010

Organization subpart

No

Name

Mr. Jeffrey P Costello

Title

Cfo

Phone

(574) 647-3549

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

• Victoria Gonzalez

  • Family Nurse Practitioner
  • Elkhart, IN
  • NPI 1861168460
  NPD
• Israr Azim Siddiqi, M.D.

  • Sleep Medicine (Internal Medicine) Physician
  • Elkhart, IN
  • NPI 1346289501

  Sleep Medicine

  NPD

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Tax ID family

Goshen Family27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

• Beacon Medical Group Inc

  • Anesthesiology Physician
  • Elkhart, IN
  • NPI 1437803285
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617
  NPD tax ID
• Beacon Medical Group, Inc.

  • Internal Medicine Physician
  • Elkhart, IN
  • NPI 1114262078
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Middlebury, IN
  • NPI 1114363835
  NPD tax ID
• Beacon Medical Group, Inc.

  • Nephrology Physician
  • South Bend, IN
  • NPI 1124423546
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Wakarusa, IN
  • NPI 1184641706
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1275550899
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Goshen, IN
  • NPI 1306863915
  NPD tax ID
• Beacon Medical Group, Inc.

  • Obstetrics & Gynecology Physician
  • Elkhart, IN
  • NPI 1316073372
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Bristol, IN
  • NPI 1447285697
  NPD tax ID
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Nappanee, IN
  • NPI 1457378069
  NPD tax ID
• Beacon Medical Group, Inc.

  • Pediatric Critical Care Medicine Physician
  • South Bend, IN
  • NPI 1467408237
  NPD tax ID

• Beacon Medical Group Sleep Medicine Doing business as
• Beacon Medical Group Sleep Medicine Elkhart East Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 5, 2023.

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683244800000",
    "number": "1881925188",
    "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": "525 W BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142964",
            "telephone_number": "574-262-0239",
            "fax_number": "574-262-8391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 County Road 6 East",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465147673",
            "country_code": "US",
            "telephone_number": "574-264-9635",
            "fax_number": "574-262-0398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200977370",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Medical Group Sleep Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Medical Group Sleep Medicine Elkhart East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc.
• Beacon Medical Group, Inc.
• Beacon Occupational Health, LLC
• Carol Joann Beathea, PHD LCSW MSW
• David A Beatty, MD
• Patricia Beck
• Samantha Jo Beck, DPT

• All providers in Elkhart, IN
• Sleep Medicine (Internal Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.