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

Q: 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.

Q: 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.

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: October 18, 2026.

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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 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

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, 94 practice at this address and 365 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

Asad Ansari, MD

Pediatric Medicine

NPI 1053387175

100 NAVARRE PL STE 5550
South Bend, IN 46601

(574) 647-2550

✔ PECOS✔ Accepts MedicareSame address

Andrew Berkson, DO

Physical Medicine and Rehabilitation

NPI 1255304010

100 NAVARRE PL STE 6600
South Bend, IN 46601

(574) 647-8800

✔ PECOS✔ Accepts MedicareSame address

Amy Deel, NP

Nurse Practitioner

NPI 1730547738

100 NAVARRE PL STE 4440
South Bend, IN 46601

(574) 647-5300

✔ PECOSSame address

Margaret Dhom, SLP

Qualified Speech Language Pathologist

NPI 1467817791

100 NAVARRE PL STE 4460
South Bend, IN 46601

(574) 235-1010

✔ Accepts MedicareSame address

Willie Donald, M.D.

Obstetrics/Gynecology

NPI 1225026669

100 NAVARRE PL STE 4410
South Bend, IN 46601

(574) 647-1650

✔ PECOS✔ Accepts MedicareSame address

Gregg Ebersole, M.D.

Orthopedic Surgery

NPI 1093000366

100 NAVARRE PL STE 4440
South Bend, IN 46601

(574) 647-5300

✔ PECOS✔ Accepts MedicareSame address

Andrea Edmister, AUD

Qualified Audiologist

NPI 1265766703

100 NAVARRE PL STE 4460
South Bend, IN 46601

(574) 235-1010

✔ Accepts MedicareSame address

Samira El Zind, MD

Neurology

NPI 1326065285

100 NAVARRE PL STE 5550
South Bend, IN 46601

(574) 647-2550

✔ PECOSSame address

Marcy Floyd, FNP-C

Nurse Practitioner

NPI 1215623301

100 NAVARRE PL STE 4440
South Bend, IN 46601

(574) 647-5300

✔ PECOS✔ Accepts MedicareSame address

Stacey Le Fevre Young, PSYD

Clinical Psychologist

NPI 1538470018

100 NAVARRE PL STE 5570
South Bend, IN 46601

(574) 647-8610

✔ PECOS✔ Accepts MedicareSame address

Donald Mohs, MD

Otolaryngology

NPI 1942385174

100 NAVARRE PL STE 4460
South Bend, IN 46601

(574) 235-1010

✔ PECOS✔ Accepts MedicareSame address

Tricia Moreno, AUD

Qualified Audiologist

NPI 1023172186

100 NAVARRE PL STE 4460
South Bend, IN 46601

(574) 235-1010

✔ Accepts MedicareSame address

Amrita Patel, MD

Physical Medicine and Rehabilitation

NPI 1144455759

100 NAVARRE PL STE 6600
South Bend, IN 46601

(574) 647-8800

✔ PECOS✔ Accepts MedicareSame address

Neal Patel, M.D.

Neurosurgery

NPI 1346475951

100 NAVARRE PL STE 6600 SUITE 6600
South Bend, IN 46601

(574) 232-7227

✔ PECOS✔ Accepts MedicareSame address

Kevin Taubman, M.D.

General Surgery

NPI 1811101132

100 NAVARRE PL STE 5500
South Bend, IN 46601

(574) 647-5200

✔ PECOS✔ Accepts MedicareSame address

Venu Vadlamudi, M.D.

Interventional Radiology

NPI 1952508699

100 NAVARRE PL STE 5500
South Bend, IN 46601

(574) 647-5200

✔ PECOS✔ Accepts MedicareSame address

Michael Hall, M.D.

Diagnostic Radiology

NPI 1093893026

100 NAVARRE PL STE 5500
South Bend, IN 46601

(574) 647-5200

✔ PECOS✔ Accepts MedicareSame address

Allison Molencupp, CNM

Certified Nurse Midwife (CNM)

NPI 1003795121

100 NAVARRE PL STE 4470
South Bend, IN 46601

(574) 647-1405

✔ PECOSSame address

Kevin Cumper, M.D.

Infectious Disease

NPI 1285072454

621 MEMORIAL DR STE 624
South Bend, IN 46601

(574) 647-8177

✔ PECOS✔ Accepts MedicareSame address

Michael Kozak, MD

Family Practice

NPI 1558623686

621 MEMORIAL DR STE 402
South Bend, IN 46601

(574) 400-4550

✔ PECOS✔ Accepts MedicareSame address

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.

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.

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, 94 practice at this address and 365 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.