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BEACON MEDICAL GROUP WAKARUSA
NPI 1184641706
Family Medicine in Wakarusa, IN

Active since July 17, 2006CLIA 15D2232582 · Waiver
207 N ELKHART ST, WAKARUSA, IN 46573(574) 862-2165(574) 862-4112 Get Directions Write a Review

NPPES record last updated: March 4, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 4, 2024, Oct 27, 2016, Sep 21, 2016 (3 updates tracked since 2016).

About Beacon Medical Group Wakarusa NPPES

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

BEACON MEDICAL GROUP WAKARUSA (NPI 1184641706) is a healthcare organization registered as a family medicine in Wakarusa, Indiana and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through August 15, 2027 and lists Jeffrey P Costello, Cfo, as its authorized official.

NPPES Registry Identity

NPI1184641706
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address207 N ELKHART STWakarusa, IN 46573-9729
Mailing Address710 N Niles AveSouth Bend, IN 46617-1924 · (574) 647-1610 · Fax (574) 237-6069
Phone(574) 862-2165
Fax(574) 862-4112
Organization SubpartNo
Authorized OfficialJeffrey P CostelloCfo · (574) 647-3549
Enumeration DateJuly 17, 2006
Last NPPES UpdateMarch 4, 20243 updates tracked since enumeration
NPPES CertifiedMarch 4, 2024
✔ NPI 1184641706 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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 ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
207 N ELKHART ST, Wakarusa, IN 46573
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Other Names 1

Doing Business AsBeacon Medical Group Wakarusa

Other Identifiers 2

OtherANTHEM BCBSIN · 000000110760
Medicaid200019030AIN

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 Anthem Blue Cross and Blue Shield.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 15D2232582

Beacon Medical Group Wanee · Nappanee, IN
Active · expires Aug 15, 2027
CLIA Number15D2232582
Laboratory TypePhysician Office
Certificate Effective DateAugust 16, 2025
Certificate Expiration DateAugust 15, 2027
Laboratory DirectorEric J. Miller
Laboratory Phone(574) 862-2165
Laboratory LocationBeacon Medical Group Wanee2102 North Main Street, Nappanee, IN 46550
CLIA data matches this NPI record on: 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 1184641706. It was assigned to this organization in the NPPES registry on July 17, 2006. The provider is doing business as Beacon Medical Group Wakarusa.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 207 N Elkhart St, Wakarusa, IN 46573. The listed phone number is (574) 862-2165.

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 15D2232582) is associated with this NPI, valid through August 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Beacon Medical Group, Inc. accept?

Health plans from 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 March 4, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.