| NPI | 1124079330 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2006-05-12 |
| Last Updated | 2024-09-30 |
| Authorized Official | Jeffrey Costello VP-CFO Phone: 5746473549 |
| Mailing Address | 710 N Niles Ave South Bend, IN 46617-1924 United States Phone: (574) 647-1610 📍 View Map |
| Primary Practice Address | 1815 E Ireland Rd South Bend, IN 46614-2845 United States Phone: (574) 647-1700 | Fax: (574) 291-3351 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | IN | 100224050B | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 207Q00000X – Family Medicine | IN | 01043622A |
| No | 207QS0010X – Family Medicine, Sports Medicine | — | — |
| No | 207RR0500X – Internal Medicine, Rheumatology | — | — |
| No | 363LF0000X – Nurse Practitioner, Family | — | — |
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About NPI 1124079330
Beacon Medical Group, Inc. is an organization registered in the CMS NPPES NPI Registry with NPI number 1124079330. The primary specialty listed is Family Medicine. The organization is located in South Bend, IN. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-05-12. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1124079330?
NPI 1124079330 belongs to Beacon Medical Group, Inc., a Family Medicine in South Bend, IN. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1124079330 active?
The current status of NPI 1124079330 in the NPPES registry is Active. The record was last updated on 2024-09-30.
What specialty is NPI 1124079330?
NPI 1124079330 is classified under the taxonomy Family Medicine. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1124079330?
You can verify NPI 1124079330 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1124079330?
The primary practice address on file for NPI 1124079330 is 1815 E Ireland Rd, South Bend, IN 46614-2845. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1124079330 issued?
NPI 1124079330 was first issued (enumerated) on 2006-05-12. The NPPES record was last updated on 2024-09-30.
Practice Location Map
Beacon Medical Group, Inc. is located at 1815 E Ireland Rd, South Bend, IN. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Beacon Medical Group, Inc.. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1124079330. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Family Medicine | 01043622A | IN |