BEACON MEDICAL GROUP MIDDLEBURY - NPI 1114363835 - Family Medicine in Middlebury, IN

Q: What is Beacon Medical Group, Inc.'s NPI number?

The NPI number for Beacon Medical Group, Inc. is 1114363835. It was assigned to this organization in the NPPES registry on May 21, 2013. The provider is doing business as Beacon Medical Group Middlebury.

Q: What is Beacon Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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About Beacon Medical Group Middlebury NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEACON MEDICAL GROUP MIDDLEBURY (NPI 1114363835) is a healthcare organization registered as a family medicine in Middlebury, Indiana and active in the NPI registry since May 2013. The organization holds a CLIA Waiver certificate valid through June 19, 2028 and lists Jeffrey P. Costello, Cfo, as its authorized official.

NPPES Registry Identity

NPI1114363835

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameBEACON MEDICAL GROUP, INC.

Location Address206 W WARREN STMiddlebury, IN 46540-9410

Mailing Address710 N Niles AveSouth Bend, IN 46617-1924 · (574) 647-1610 · Fax (574) 237-6069

Phone(574) 825-2146

Fax(574) 524-7435

Organization SubpartNo

Authorized OfficialJeffrey P. CostelloCfo · (574) 647-3549

Enumeration DateMay 21, 2013

Last NPPES UpdateMarch 4, 20242 updates tracked since enumeration

NPPES CertifiedMarch 4, 2024

✔ NPI 1114363835 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family 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.

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X

206 W WARREN ST, Middlebury, IN 46540

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Other Names 1

Doing Business AsBeacon Medical Group Middlebury

Other Identifiers 1

Medicaid100114000GIN

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D0356768

Beacon Med Grp - Middlebury · Middlebury, IN

Active · expires Jun 19, 2028

CLIA Number15D0356768

Laboratory TypePhysician Office

Certificate Effective DateJune 20, 2026

Certificate Expiration DateJune 19, 2028

Laboratory DirectorJames Handtke

Laboratory Phone(574) 825-2146

Laboratory LocationBeacon Med Grp - Middlebury206 W Warren St, Middlebury, IN 46540

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMES ALAN HANDTKE DO

Family Medicine