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BEACON MEDICAL GROUP PORTAGE ROAD
NPI 1568413359
Family Medicine in South Bend, IN

Active since May 15, 2006
3575 PORTAGE AVE, SOUTH BEND, IN 46628(574) 647-4530 Get Directions Write a Review

NPPES record last updated: September 27, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Beacon Medical Group Portage Road NPPES

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

BEACON MEDICAL GROUP PORTAGE ROAD (NPI 1568413359) is a healthcare organization registered as a family medicine in South Bend, Indiana and active in the NPI registry since May 2006. The organization lists Jeffrey Costello, Vp-cfo, as its authorized official.

NPPES Registry Identity

NPI1568413359
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address3575 PORTAGE AVESouth Bend, IN 46628-6092
Mailing Address53842 Generations DrSouth Bend, IN 46635-1543
Phone(574) 647-4530
Organization SubpartNo
Authorized OfficialJeffrey CostelloVp-cfo · (574) 647-3549
Enumeration DateMay 15, 2006
Last NPPES UpdateSeptember 27, 2013
✔ NPI 1568413359 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IN · 01054535A
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.
3575 PORTAGE AVE, South Bend, IN 46628
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Other Names 1

Doing Business AsBeacon Medical Group Portage Road

Other Identifiers 2

Medicare PIN247000IN
Medicaid100092700BIN

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

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

MICHIANA FAMILY DENTAL LLC
Dentist
3575 PORTAGE AVE
SOUTH BEND, IN 46628
St. Joseph County (203) 215-4687

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 1568413359. It was assigned to this organization in the NPPES registry on May 15, 2006. The provider is doing business as Beacon Medical Group Portage Road.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 3575 Portage Ave, South Bend, IN 46628. The listed phone number is (574) 647-4530.

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

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Beacon Medical Group, Inc. was last updated on September 27, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.