BEACON MEDICAL GROUP BITTERSWEET COMMONS (BEACON MEDICAL GROUP, INC.) NPI 1003042318

Family Medicine in Granger, IN

NPI 1003042318 Organization Family Medicine CLIA Number 15D1101762 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

About BEACON MEDICAL GROUP BITTERSWEET COMMONS (BEACON MEDICAL GROUP, INC.)

Beacon Medical Group Bittersweet Commons (beacon Medical Group, Inc.) is a primary care provider established in Granger, Indiana specializing in family medicine. The NPI number of Beacon Medical Group Bittersweet Commons (beacon Medical Group, Inc.) is 1003042318 and was assigned on June 2009. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated 3 years ago. Beacon Medical Group Bittersweet Commons (beacon Medical Group, Inc.) operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Beacon Medical Group Bittersweet Commons. The authorized official of this NPI record is Mr. Jeffrey P Costello (Cfo)

A primary care provider (PCP) like Beacon Medical Group Bittersweet Commons sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

The CLIA number of Beacon Medical Group Bittersweet Commons is 15D1101762 registered as a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to Beacon Medical Group Bittersweet Commons in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1003042318

Provider NameBEACON MEDICAL GROUP BITTERSWEET COMMONS (BEACON MEDICAL GROUP, INC.)
Provider Location Address12340 BITTERSWEET COMMONS BLVD W GRANGER, IN 46530
Provider Mailing Address710 N NILES AVE SOUTH BEND, IN 46617
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameBEACON MEDICAL GROUP BITTERSWEET COMMONS
Other Name TypeDoing Business As (3)
Enumeration Date06-02-2009
Last Update Date07-24-2018


Primary Taxonomy

Taxonomy Code207Q00000X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License StateIN
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Business Address

BEACON MEDICAL GROUP BITTERSWEET COMMONS
12340 BITTERSWEET COMMONS BLVD W
GRANGER, IN
ZIP 46530
Phone: (574) 271-8610
Fax: (574) 271-8620

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Mailing Address

BEACON MEDICAL GROUP BITTERSWEET COMMONS
710 N NILES AVE
SOUTH BEND, IN
ZIP 46617
Phone: (574) 647-1610
Fax: (574) 237-6069



Authorized Official

Authorized Official NameMR. JEFFREY P COSTELLO
Authorized Official TitleCFO
Authorized Official Phone(574) 647-3549

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003042318 is:

CLIA Number15D1101762
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
100114000FMEDICAID (05)IN
000000631897OTHER (01)IN

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1376737387DR. SHELLEY A. MORRIS D.O.
Individual
Family Medicine12340 BITTERSWEET COMMONS BLVD W
GRANGER, IN 46530
(574) 271-8610
1114265204MRS. TAMMY GENE SLOTT FNP-BC
Individual
Nurse Practitioner (Family)12340 BITTERSWEET COMMONS BLVD W
GRANGER, IN 46530
(574) 271-8610

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.