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BEACON MEDICAL GROUP ONCOLOGY ELKHART
NPI 1770775009
Radiology - Radiation Oncology in South Bend, IN

Active since August 10, 2007CLIA 15D2307850 · Waiver
621 MEMORIAL DR STE 100, SOUTH BEND, IN 46601(574) 647-1100(574) 647-5907 Get Directions Write a Review

NPPES record last updated: April 28, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 9, 2021, Jan 15, 2021, Jan 22, 2020 and 2 more (5 updates tracked since 2016).

About Beacon Medical Group Oncology Elkhart NPPES

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

BEACON MEDICAL GROUP ONCOLOGY ELKHART (NPI 1770775009) is a healthcare organization registered as a radiation oncology in South Bend, Indiana and active in the NPI registry since August 2007. The organization holds a CLIA Waiver certificate valid through July 15, 2028, maintains a secondary practice location in Elkhart, and lists Jeffrey P. Costello, Vp-cfo, as its authorized official.

NPPES Registry Identity

NPI1770775009
Entity TypeOrganization
Primary Taxonomy2085R0001X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address621 MEMORIAL DR STE 100South Bend, IN 46601-1063
Mailing Address710 N Niles AveSouth Bend, IN 46617-1924 · (574) 647-1817
Phone(574) 647-1100
Fax(574) 647-5907
Organization SubpartNo
Authorized OfficialJeffrey P. CostelloVp-cfo · (574) 647-3549
Enumeration DateAugust 10, 2007
Last NPPES UpdateApril 28, 20235 updates tracked since enumeration
NPPES CertifiedApril 28, 2023
✔ NPI 1770775009 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRadiology · Radiation OncologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0001X
License✔ Licensed in IN · 01021173A
Definition
A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.
Also ListedInternal Medicine · Hematology & OncologyTaxonomy 207RH0003X
621 MEMORIAL DR STE 100, South Bend, IN 46601
Open in Google Maps ↗

Other Names 2

Doing Business AsBeacon Medical Group Oncology Elkhart
Doing Business AsBeacon Medical Group Oncology South Bend

Secondary Practice Location 1

Location 11215 Lawn Ave Ste 120Elkhart, IN 46514-2450 · Phone (574) 523-2733 · Fax (574) 523-3251

Other Identifiers 1

Medicaid300046000IN

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 15D2307850

Beacon Medical Group Oncology South Bend · South Bend, IN
Active · expires Jul 15, 2028
CLIA Number15D2307850
Laboratory TypePhysician Office
Certificate Effective DateJuly 16, 2026
Certificate Expiration DateJuly 15, 2028
Laboratory DirectorNonyem A. Onujiogu
Laboratory Phone(574) 647-1100
Laboratory LocationBeacon Medical Group Oncology South Bend621 Memorial Dr, Ste 100, 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 5

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

JENNIFER ANN HARTL FNP-C
Nurse Practitioner (Family)
621 MEMORIAL DR STE 100
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1100
KRISTEN A ATWOOD APN
Nurse Practitioner (Family)
621 MEMORIAL DR STE 100
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1100
NICOLE ROGERS
Physician Assistant
621 MEMORIAL DR STE 100
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1100
KASSI J BROOKS LCGC
Genetic Counselor, MS
621 MEMORIAL DR STE 100
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1100
ALISON HAFFNER NP
Nurse Practitioner (Family)
621 MEMORIAL DR STE 100
SOUTH BEND, IN 46601
St. Joseph County (574) 647-1100

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 1770775009. It was assigned to this organization in the NPPES registry on August 10, 2007. The provider is doing business as Beacon Medical Group Oncology Elkhart and Beacon Medical Group Oncology South Bend.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 621 Memorial Dr Ste 100, South Bend, IN 46601. The listed phone number is (574) 647-1100.

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

The primary specialty registered for this NPI is Radiology, specializing in Radiation Oncology, with taxonomy code 2085R0001X.

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

Yes. A Certificate of Waiver (number 15D2307850) is associated with this NPI, valid through July 15, 2028. 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 April 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.