Beacon Medical Group, INC.

in South Bend, IN. Organization (NPI-2).

NPI number1770775009

StatusActive

Last updated in NPPESApr 28, 2023

Details

NPI: 1770775009
Entity type: Organization (NPI-2)
Legal business name: Beacon Medical Group, INC.
Organization subpart: No
Enumeration date: Aug 10, 2007
Certification date: Apr 28, 2023
Last updated: Apr 28, 2023

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2085R0001X		01021173A	IN	Yes
207RH0003X	Internal Medicine, Hematology & Oncology	–	–

Other names

Beacon Medical Group Oncology South Bend (Doing Business As)
Beacon Medical Group Oncology Elkhart (Doing Business As)

Practice location

621 Memorial Dr Ste 100
South Bend, IN 46601-1063

Phone 574-647-1100 · Fax 574-647-5907

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924

Phone 574-647-1817

Other practice locations

1215 Lawn Ave Ste 120
Elkhart, IN 46514-2450

Phone 574-523-2733 · Fax 574-523-3251

Authorized official

Jeffrey P. Costello
Vp-Cfo
5746473549

Is something wrong?

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