Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

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

Q: 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.

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

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

Active since May 12, 2006

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: August 02, 2026.

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

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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 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 ›

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)