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BEACON MEDICAL GROUP, INC.
NPI 1710939608
Obstetrics & Gynecology - Maternal & Fetal Medicine in South Bend, IN

Active since May 17, 2006CLIA 15D2325559 · Waiver
100 NAVARRE PL STE 4410, SOUTH BEND, IN 46601(574) 647-6370(574) 647-6373 Get Directions Write a Review

NPPES record last updated: February 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 16, 2025, Aug 29, 2016 (2 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 1710939608), doing business as Beacon Medical Group Maternal Fetal Medicine South Bend, is a healthcare organization registered as a maternal & fetal medicine in South Bend, Indiana and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through June 15, 2027 and lists Jeffrey Costello, Vp-cfo, as its authorized official.

NPPES Registry Identity

NPI1710939608
Entity TypeOrganization
Primary Taxonomy207VM0101X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address100 NAVARRE PL STE 4410South Bend, IN 46601-1171
Mailing Address3245 Health Dr Ste 100Granger, IN 46530-1380 · (574) 647-3725
Phone(574) 647-6370
Fax(574) 647-6373
Organization SubpartNo
Authorized OfficialJeffrey CostelloVp-cfo · (574) 647-3549
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 10, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 10, 2026
✔ NPI 1710939608 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyObstetrics & Gynecology · Maternal & Fetal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207VM0101X
License✔ Licensed in IN · 01053966A
Definition
An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies.
Also ListedGenetic Counselor, MSTaxonomy 170300000X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedSurgery · Surgical Critical CareTaxonomy 2086S0102X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
100 NAVARRE PL STE 4410, South Bend, IN 46601
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Other Names 1

Doing Business AsBeacon Medical Group Maternal Fetal Medicine South Bend

Other Identifiers 1

Medicaid300125576IN

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 15D2325559

Beacon Medical Group Maternal Fetal Medicine South Bend · South Bend, IN
Active · expires Jun 15, 2027
CLIA Number15D2325559
Laboratory TypePhysician Office
Certificate Effective DateJune 16, 2025
Certificate Expiration DateJune 15, 2027
Laboratory DirectorTorre Halscott
Laboratory Phone(574) 647-6370
Laboratory LocationBeacon Medical Group Maternal Fetal Medicine South Bend100 Navarre Pl, Ste 4410, 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.

Other Providers at the Same Location NPPES 4

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

GLORIA SUE HOFFMAN
Registered Nurse
100 NAVARRE PL STE 4410
SOUTH BEND, IN 46601
St. Joseph County (574) 647-6370
DR. WILLIE LEE DONALD M.D.
Obstetrics & Gynecology (Maternal & Fetal Medicine)
100 NAVARRE PL STE 4410
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1650
DR. MICAELA DELLA TORRE M.D.
Obstetrics & Gynecology (Maternal & Fetal Medicine)
100 NAVARRE PL STE 4410
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1650
MRS. ANGELA MARIE FAULKNER FNP
Nurse Practitioner (Family)
100 NAVARRE PL STE 4410
SOUTH BEND, IN 46601
St. Joseph County (574) 647-6370

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 1710939608. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Beacon Medical Group Maternal Fetal Medicine South Bend.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 100 Navarre Pl Ste 4410, South Bend, IN 46601. The listed phone number is (574) 647-6370.

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

The primary specialty registered for this NPI is Obstetrics & Gynecology, specializing in Maternal & Fetal Medicine, with taxonomy code 207VM0101X.

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

Yes. A Certificate of Waiver (number 15D2325559) is associated with this NPI, valid through June 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 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 February 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.