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BEACON MEDICAL GROUP, INC.
NPI 1124423546
Internal Medicine - Nephrology in South Bend, IN

Active since October 28, 2014
100 NAVARRE PL STE 4400, SOUTH BEND, IN 46601(574) 647-1972(574) 647-1974 Get Directions Write a Review

NPPES record last updated: October 12, 2017. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Beacon Medical Group, Inc. NPPES

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

BEACON MEDICAL GROUP, INC. (NPI 1124423546) is a healthcare organization registered as a nephrology in South Bend, Indiana and active in the NPI registry since October 2014. The organization maintains a secondary practice location in South Bend and lists Jeffrey P. Costello, Cfo, as its authorized official.

NPPES Registry Identity

NPI1124423546
Entity TypeOrganization
Primary Taxonomy207RN0300X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address100 NAVARRE PL STE 4400South Bend, IN 46601-1100
Mailing Address710 N Niles AveSouth Bend, IN 46617-1924 · (574) 647-1610 · Fax (574) 237-6069
Phone(574) 647-1972
Fax(574) 647-1974
Organization SubpartNo
Authorized OfficialJeffrey P. CostelloCfo · (574) 647-3549
Enumeration DateOctober 28, 2014
Last NPPES UpdateOctober 12, 2017
✔ NPI 1124423546 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

100 NAVARRE PL STE 4400, South Bend, IN 46601
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Secondary Practice Location 1

Location 1100 Navarre Pl Ste 4405South Bend, IN 46601-1176 · Phone (574) 647-1972 · Fax (574) 647-1974

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

Other Providers at the Same Location NPPES 2

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

LESLIE NICOLE KANIUK NP
Nurse Practitioner (Family)
100 NAVARRE PL STE 4400
SOUTH BEND, IN 46601
St. Joseph County (574) 647-2501
JAMES W KOZELKA MD
Psychiatry & Neurology (Neurology)
100 NAVARRE PL STE 4400
SOUTH BEND, IN 46601
St. Joseph County (574) 647-2501

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 1124423546. It was assigned to this organization in the NPPES registry on October 28, 2014.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 100 Navarre Pl Ste 4400, South Bend, IN 46601. The listed phone number is (574) 647-1972.

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

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

When was this NPI record last updated?

The NPPES record for Beacon Medical Group, Inc. was last updated on October 12, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.