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BEACON MEDICAL GROUP, INC.
NPI 1295087500
Otolaryngology - Otolaryngology/Facial Plastic Surgery in Elkhart, IN

Active since October 10, 2012CLIA 15D2057229 · Waiver
1753 FULTON ST, ELKHART, IN 46514(574) 293-9448(574) 293-9480 Get Directions Write a Review

NPPES record last updated: October 12, 2017. Verified against the NPPES registry weekly; last sync: August 09, 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 1295087500) is a healthcare organization registered as an otolaryngology/facial plastic surgery in Elkhart, Indiana and active in the NPI registry since October 2012. The organization holds a CLIA Waiver certificate valid through April 10, 2027, maintains a secondary practice location in Elkhart, and lists Jeffrey P Costello, Cfo, as its authorized official.

NPPES Registry Identity

NPI1295087500
Entity TypeOrganization
Primary Taxonomy207YX0905X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address1753 FULTON STElkhart, IN 46514-1927
Mailing Address710 N Niles AveSouth Bend, IN 46617-1924 · (574) 647-1610 · Fax (574) 237-6069
Phone(574) 293-9448
Fax(574) 293-9480
Organization SubpartNo
Authorized OfficialJeffrey P CostelloCfo · (574) 647-3549
Enumeration DateOctober 10, 2012
Last NPPES UpdateOctober 12, 2017
✔ NPI 1295087500 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOtolaryngology · Otolaryngology/Facial Plastic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207YX0905X
Definition
An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.
Also ListedOtolaryngologyTaxonomy 207Y00000X
Also ListedAudiologistTaxonomy 231H00000X
1753 FULTON ST, Elkhart, IN 46514
Open in Google Maps ↗

Secondary Practice Location 1

Location 11753 Fulton StElkhart, IN 46514-1927 · Phone (574) 293-9448 · Fax (574) 293-9480

Other Identifiers 1

Medicare PIN262950IN

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 ›

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 15D2057229

Beacon Medical Group Ent And Audiology Elkhart · Elkhart, IN
Active · expires Apr 10, 2027
CLIA Number15D2057229
Laboratory TypePhysician Office
Certificate Effective DateApril 11, 2025
Certificate Expiration DateApril 10, 2027
Laboratory DirectorAndrea L. Gentile
Laboratory Phone(574) 293-9448
Laboratory LocationBeacon Medical Group Ent And Audiology Elkhart1753 Fulton St, Elkhart, IN 46514
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

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

ADAM JAMES TYLER APRN
Nurse Practitioner
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 293-9448
DR. JAMES R MILLER M.D.
General Practice
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 389-9881
JORDAN LEIGH BERGSTROM AU.D.
Audiologist
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 293-9448
DR. COURTNEY ELIZABETH HART AUD
Audiologist
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 293-9448
DR. ELIZABETH MARIE STOCKWELL AUD
Audiologist
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 293-9448
ALEXA M ROZYCKI AUD
Audiologist
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 293-9448
MS. ANDREA LESLIE GENTILE M.D.
Otolaryngology
1753 FULTON ST
ELKHART, IN 46514
Elkhart County (574) 293-9448

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 1295087500. It was assigned to this organization in the NPPES registry on October 10, 2012.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 1753 Fulton St, Elkhart, IN 46514. The listed phone number is (574) 293-9448.

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

The primary specialty registered for this NPI is Otolaryngology, specializing in Otolaryngology/Facial Plastic Surgery, with taxonomy code 207YX0905X.

Does Beacon Medical Group, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2057229) is associated with this NPI, valid through April 10, 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 Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and 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 October 12, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.