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BEACON MEDICAL GROUP, INC.
NPI 1124079330
Family Medicine in South Bend, IN

Active since May 12, 2006CLIA 15D2346588 · Waiver
1815 E IRELAND RD, SOUTH BEND, IN 46614(574) 647-1700(574) 291-3351 Get Directions Write a Review

NPPES record last updated: June 25, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Sep 30, 2024, Mar 4, 2024, Aug 29, 2016 (3 updates tracked since 2016).

About Beacon Medical Group, Inc. NPPES

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

BEACON MEDICAL GROUP, INC. (NPI 1124079330), doing business as Beacon Medical Group Ireland Road, is a healthcare organization registered as a family medicine in South Bend, Indiana and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through July 1, 2028, maintains a secondary practice location in Plymouth, and lists Jeffrey Costello, Vp-cfo, as its authorized official.

NPPES Registry Identity

NPI1124079330
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address1815 E IRELAND RDSouth Bend, IN 46614-2845
Mailing Address3245 Health Dr Ste 100Granger, IN 46530-1380 · (574) 647-3725
Phone(574) 647-1700
Fax(574) 291-3351
Organization SubpartNo
Authorized OfficialJeffrey CostelloVp-cfo · (574) 647-3549
Enumeration DateMay 12, 2006
Last NPPES UpdateJune 25, 20263 updates tracked since enumeration
NPPES CertifiedJune 25, 2026
✔ NPI 1124079330 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 9

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IN · 01043622A
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 ListedFamily Medicine · Sports MedicineTaxonomy 207QS0010X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X
Also ListedInternal Medicine · RheumatologyTaxonomy 207RR0500X
Also ListedNeurological SurgeryTaxonomy 207T00000X
Also ListedRadiology · Diagnostic UltrasoundTaxonomy 2085U0001X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
1815 E IRELAND RD, South Bend, IN 46614
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Other Names 2

Doing Business AsBeacon Medical Group Ireland Road
Doing Business AsBeacon Medical Group Plymouth

Secondary Practice Location 1

Location 1576 N Oak DrPlymouth, IN 46563-1664 · Phone (574) 647-5170 · Fax (574) 647-5183

Other Identifiers 2

Medicaid100224050BIN
Medicaid300132559IN

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 15D2346588

Beacon Medical Group Plymouth · Plymouth, IN
Active · expires Jul 1, 2028
CLIA Number15D2346588
Laboratory TypePhysician Office
Certificate Effective DateJuly 2, 2026
Certificate Expiration DateJuly 1, 2028
Laboratory DirectorKeyna A. Martinez
Laboratory Phone(574) 647-5170
Laboratory LocationBeacon Medical Group Plymouth576 N Oak Drive, Plymouth, IN 46563
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

DR. TRAVIS WEAVER D.O.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1700
RUCHITA KACHRU MD
Pediatrics
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1700
MRS. TRICIA A WALTERS M.D.
Family Medicine
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1750
ZHAIJUN FAN DO
Family Medicine
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1750
AMANDA LEANNE SPRINGER MD
Family Medicine
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1700
CATHERINE N WOLFF DO
Internal Medicine
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1700
MOLLY PESTOW NP
Nurse Practitioner (Family)
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1700
MARLISE ANN WEBBER NP
Nurse Practitioner
1815 E IRELAND RD
SOUTH BEND, IN 46614
St. Joseph County (574) 647-1750

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

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

The NPI number for Beacon Medical Group, Inc. is 1124079330. It was assigned to this organization in the NPPES registry on May 12, 2006. The provider is doing business as Beacon Medical Group Ireland Road and Beacon Medical Group Plymouth.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 1815 E Ireland Rd, South Bend, IN 46614. The listed phone number is (574) 647-1700.

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

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

Does Beacon Medical Group, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2346588) is associated with this NPI, valid through July 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Beacon Medical Group, Inc. accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and Anthem Blue Cross and Blue Shield list Beacon Medical Group, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Beacon Medical Group, Inc. was last updated on June 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.