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BEACON MEDICAL GROUP, INC.
NPI 1548415474
Pediatrics in South Bend, IN

Active since November 19, 2008CLIA 15D1099816 · Waiver
100 NAVARRE PL STE 5550, SOUTH BEND, IN 46601(574) 647-2550(574) 647-1129 Get Directions Write a Review

NPPES record last updated: July 21, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 4, 2024, Aug 6, 2018, Aug 30, 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 1548415474), doing business as Beacon Medical Group Pediatric Multi-specialty, is a healthcare organization registered as a pediatrics in South Bend, Indiana and active in the NPI registry since November 2008. The organization holds a CLIA Waiver certificate valid through May 20, 2027, maintains a secondary practice location in South Bend, and lists Jeffrey P Costello, Vice President/cfo, as its authorized official.

NPPES Registry Identity

NPI1548415474
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address100 NAVARRE PL STE 5550South Bend, IN 46601-1169
Mailing Address3245 Health Dr Ste 100Granger, IN 46530-1380 · (574) 647-1069
Phone(574) 647-2550
Fax(574) 647-1129
Organization SubpartNo
Authorized OfficialJeffrey P CostelloVice President/cfo · (574) 647-3549
Enumeration DateNovember 19, 2008
Last NPPES UpdateJuly 21, 20253 updates tracked since enumeration
NPPES CertifiedJuly 21, 2025
✔ NPI 1548415474 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in IN · 01065535A
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedPsychologistTaxonomy 103T00000X
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X
Also ListedDietitian, RegisteredTaxonomy 133V00000X
Also ListedPediatrics · Neonatal-Perinatal MedicineTaxonomy 2080N0001X
Also ListedPediatrics · Pediatric PulmonologyTaxonomy 2080P0214X
Also ListedNurse PractitionerTaxonomy 363L00000X
100 NAVARRE PL STE 5550, South Bend, IN 46601
Open in Google Maps ↗

Other Names 2

Doing Business AsBeacon Medical Group Pediatric Multi-specialty
Doing Business AsBeacon Medical Group Pediatric Specialists

Secondary Practice Location 1

Location 1100 Navarre Pl Ste 5570South Bend, IN 46601-1169 · Phone (574) 647-8610 · Fax (574) 647-8615

Other Identifiers 2

Medicaid200928880AIN
Medicaid300069919IN

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, 95 practice at this address and 367 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
Haley Boyd, NP
Nurse Practitioner
NPI 1821706763
100 NAVARRE PL STE 6600
South Bend, IN 46601
(574) 647-8800
✔ PECOS✔ Accepts MedicareSame address
Megan Calkins, FNP-BC
Nurse Practitioner
NPI 1265274013
100 NAVARRE PL STE 4460
South Bend, IN 46601
(574) 235-1010
✔ PECOS✔ Accepts MedicareSame address
Robert Crumb, M.D.
Obstetrics/Gynecology
NPI 1376516732
100 NAVARRE PL STE 4470
South Bend, IN 46601
(574) 647-1405
✔ PECOS✔ Accepts MedicareSame address
Richard Fessler, MD, PHD
Neurosurgery
NPI 1134641038
100 NAVARRE PL STE 6600
South Bend, IN 46601
(574) 647-8800
✔ PECOS✔ Accepts MedicareSame address
Daniel Fulkerson, M.D.
Neurosurgery
NPI 1386802387
100 NAVARRE PL STE 6600
South Bend, IN 46601
(574) 647-8800
✔ PECOS✔ Accepts MedicareSame address
Francis Hussey, MD
Obstetrics/Gynecology
NPI 1902809213
100 NAVARRE PL STE 4470
South Bend, IN 46601
(574) 647-1405
✔ PECOS✔ Accepts MedicareSame address
Christopher Ketcham, DO
Physical Medicine and Rehabilitation
NPI 1780098780
100 NAVARRE PL STE 4440
South Bend, IN 46601
(574) 647-5300
✔ PECOS✔ Accepts MedicareSame address
James Kozelka, MD
Neurology
NPI 1720016926
100 NAVARRE PL STE 4400
South Bend, IN 46601
(574) 647-2501
✔ PECOS✔ Accepts MedicareSame address
Carol Luzzi, MD
Pediatric Medicine
NPI 1881764579
100 NAVARRE PL STE 5570
South Bend, IN 46601
(574) 647-8610
✔ PECOS✔ Accepts MedicareSame address
Eric Mccoy, M.D.
Orthopedic Surgery
NPI 1942572797
100 NAVARRE PL STE 4440
South Bend, IN 46601
(574) 647-5300
✔ PECOS✔ Accepts MedicareSame address
Peter Miller, M.D.
Interventional Radiology
NPI 1295991081
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
Sonia Yuen, MD
Otolaryngology
NPI 1487187894
100 NAVARRE PL STE 4460
South Bend, IN 46601
(574) 235-1010
✔ 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
Thomas Poulin, MD
General Surgery
NPI 1497732556
100 NAVARRE PL STE 5500
South Bend, IN 46601
(574) 647-5200
✔ PECOS✔ Accepts MedicareSame 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
Andrea Edmister, AUD
Qualified Audiologist
NPI 1265766703
100 NAVARRE PL STE 4460
South Bend, IN 46601
(574) 235-1010
✔ 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
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.

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 15D1099816

Beacon Medical Group Pediatric Multi -Specialty · South Bend, IN
Active · expires May 20, 2027
CLIA Number15D1099816
Laboratory TypePhysician Office
Certificate Effective DateMay 21, 2025
Certificate Expiration DateMay 20, 2027
Laboratory DirectorAsad Ansari
Laboratory Phone(574) 647-2550
Laboratory LocationBeacon Medical Group Pediatric Multi -Specialty100 Navarre Pl Ste 5550, South Bend, IN 46601
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 1548415474. It was assigned to this organization in the NPPES registry on November 19, 2008. The provider is doing business as Beacon Medical Group Pediatric Multi-Specialty and Beacon Medical Group Pediatric Specialists.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 100 Navarre Pl Ste 5550, South Bend, IN 46601. The listed phone number is (574) 647-2550.

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

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

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, 95 practice at this address and 367 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 15D1099816) is associated with this NPI, valid through May 20, 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, 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 July 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.