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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: October 25, 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 ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Beacon Medical Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

734

Medicare enrollment records show 734 clinicians reassign Medicare billing to Beacon Medical Group, Inc., which bills Medicare for the services they deliver. Of these, 11 practice at this address and 363 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 45

Nurse Practitioner188
Family Practice113
Certified Registered Nurse Anesthetist (CRNA)49
Obstetrics/Gynecology49
Internal Medicine42
Neurology29
Pediatric Medicine28
Psychiatry21
37 other specialties215

Nearest to this location (20)

See all 734
Jennifer Besemer, RD, CDE
Registered Dietitian or Nutrition Professional
NPI 1578013058
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ Accepts MedicareSame address
Heather Campion, M.D.
Orthopedic Surgery
NPI 1336345040
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Mitchell Daugherty
Family Practice
NPI 1417481540
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Nicole Gauthier, LCSW
Clinical Social Worker
NPI 1790546653
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Nicole Kunar, DO
Family Practice
NPI 1790149995
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Colleen Morrison, M.D.
Pediatric Medicine
NPI 1437306552
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOSSame address
Ruth Neal, APRN
Nurse Practitioner
NPI 1396414827
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Ryan O'rourke, MD
Orthopedic Surgery
NPI 1801244827
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Jerome Skelly, M.D.
Internal Medicine
NPI 1396729893
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Travis Weaver, D.O.
Internal Medicine
NPI 1063808772
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts MedicareSame address
Marlise Webber, NP
Nurse Practitioner
NPI 1295336642
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1750
✔ PECOS✔ Accepts MedicareSame address
Douglas David, M.D.
Family Practice
NPI 1396733101
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts Medicare0.1 mi
Zhaijun Fan, DO
Family Practice
NPI 1124225578
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1750
✔ PECOS✔ Accepts Medicare0.1 mi
William Farabaugh, M.D.
Family Practice
NPI 1639167901
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts Medicare0.1 mi
Daniel Kinney, MD
Pediatric Medicine
NPI 1518123124
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS0.1 mi
Amber Lichtenbarger, MD
Family Practice
NPI 1821587874
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts Medicare0.1 mi
Shelby Patterson, FNP-C
Nurse Practitioner
NPI 1710611603
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts Medicare0.1 mi
Catherine Wolff, DO
Internal Medicine
NPI 1154378602
1815 E IRELAND RD
South Bend, IN 46614
(574) 647-1700
✔ PECOS✔ Accepts Medicare0.1 mi
Esther Adu, NP
Nurse Practitioner
NPI 1598593287
1950 RIDGEDALE RD
South Bend, IN 46614
(574) 291-6722
✔ PECOS✔ Accepts Medicare0.9 mi
John Katsaropoulos, MD
Interventional Cardiology
NPI 1063419968
3365 DEER LAKE DR
South Bend, IN 46614
(574) 276-3324
✔ PECOS✔ Accepts Medicare0.9 mi
See all 734 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

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.

Is Beacon Medical Group, Inc. enrolled in Medicare?

Yes. Beacon Medical Group, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Beacon Medical Group, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 734 clinicians in 45 Medicare specialties reassign their Medicare billing to Beacon Medical Group, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (188), Family Practice (113) and Certified Registered Nurse Anesthetist (CRNA) (49). Of these, 11 practice at this address and 363 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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, Anthem Blue Cross and Blue Shield and CareSource 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 4 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.