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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: October 25, 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 Anthem Blue Cross and Blue Shield, CareSource.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 Oncology Elkhart 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 Oncology Elkhart, which bills Medicare for the services they deliver. Of these, 95 practice at this address and 365 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
Erin Barth, MSN, RN, AGACNP-BC
Nurse Practitioner
NPI 1265951578
621 MEMORIAL DR STE 512
South Bend, IN 46601
(574) 246-9350
✔ 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
Marjorie Daoud, MD
Infectious Disease
NPI 1346276995
621 MEMORIAL DR STE 402 MEMORIAL HOSPITAL
South Bend, IN 46601
(574) 647-2500
✔ PECOS✔ Accepts MedicareSame address
Daniela Edson, AGACNP, NP
Nurse Practitioner
NPI 1447721105
621 MEMORIAL DR STE 502
South Bend, IN 46601
(574) 647-5875
✔ PECOSSame address
Michael Kozak, MD
Family Practice
NPI 1558623686
621 MEMORIAL DR STE 402
South Bend, IN 46601
(574) 400-4550
✔ PECOS✔ Accepts MedicareSame address
Kevin Small, MD
Diagnostic Radiology
NPI 1689669715
621 MEMORIAL DR STE 312
South Bend, IN 46601
(574) 647-5200
✔ PECOS✔ Accepts MedicareSame address
Scott Thomas, MD
General Surgery
NPI 1033196126
621 MEMORIAL DR SUITE 502
South Bend, IN 46601
(574) 647-5875
✔ PECOS✔ Accepts MedicareSame address
Brandon Zabukovic, M.D.
Family Practice
NPI 1710962915
621 MEMORIAL DR STE 402
South Bend, IN 46601
(574) 400-4550
✔ 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
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
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
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 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.

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.

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 365 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 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 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 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.