1. Home
  2. Directory
  3. Indiana
  4. Elkhart
  5. Pediatrics
  6. NPI Profile

BEACON MEDICAL GROUP, INC.
NPI 1861816761
Pediatrics in Elkhart, IN

Active since February 12, 2014CLIA 15D2019223 · Waiver
1627 E BRISTOL ST, ELKHART, IN 46514(574) 262-0313(574) 262-8163 Get Directions Write a Review

NPPES record last updated: August 12, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Aug 12, 2025, Aug 14, 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 1861816761), doing business as Beacon Medical Group Pediatrics Bristol Street, is a healthcare organization registered as a pediatrics in Elkhart, Indiana and active in the NPI registry since February 2014. The organization holds a CLIA Waiver certificate valid through July 6, 2028, maintains 2 additional practice locations, and lists Jeffrey P. Costello, Cfo, as its authorized official.

NPPES Registry Identity

NPI1861816761
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameBEACON MEDICAL GROUP, INC.
Location Address1627 E BRISTOL STElkhart, IN 46514-3817
Mailing Address3245 Health Dr Ste 100Granger, IN 46530-1380 · (574) 647-3725
Phone(574) 262-0313
Fax(574) 262-8163
Organization SubpartNo
Authorized OfficialJeffrey P. CostelloCfo · (574) 647-3549
Enumeration DateFebruary 12, 2014
Last NPPES UpdateAugust 12, 20253 updates tracked since enumeration
NPPES CertifiedAugust 12, 2025
✔ NPI 1861816761 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
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.
1627 E BRISTOL ST, Elkhart, IN 46514
Open in Google Maps ↗

Other Names 3

Doing Business AsBeacon Medical Group Pediatrics Bristol Street
Doing Business AsBeacon Medical Group Pediatrics Goshen
Doing Business AsBeacon Medical Group Pediatrics Rieth Blvd

Secondary Practice Locations 2

Location 12120 Rieth Blvd Ste 200Goshen, IN 46526-5867 · Phone (574) 262-0313 · Fax (574) 262-8163
Location 22606 Peddlers Village Rd Ste 218Goshen, IN 46526-1004 · Phone (574) 262-0313 · Fax (574) 262-8163

Other Identifiers 3

Medicaid100114000HIN
Medicaid100114000IIN
Medicaid300114876IN

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.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, 4 practice at this address and 175 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
Jared Dhaemers, MD
Pediatric Medicine
NPI 1770533424
1627 E BRISTOL ST
Elkhart, IN 46514
(574) 262-0313
✔ PECOSSame address
Emily Kisor, M.D.
Pediatric Medicine
NPI 1659614964
1627 E BRISTOL ST
Elkhart, IN 46514
(574) 262-0313
✔ PECOSSame address
Sarah O'connor, MD
Pediatric Medicine
NPI 1720474620
1627 E BRISTOL ST
Elkhart, IN 46514
(574) 262-0313
✔ PECOSSame address
Mary Reid, MD
Pediatric Medicine
NPI 1770574675
1627 E BRISTOL ST
Elkhart, IN 46514
(574) 262-0313
✔ PECOSSame address
Deborah Nethercutt, NP-C
Nurse Practitioner
NPI 1104312172
1621 W BEARDSLEY AVE
Elkhart, IN 46514
(574) 206-4156
✔ PECOS✔ Accepts Medicare0.2 mi
Peter Fretz, MD
Urology
NPI 1538148838
1506 OSOLO ROAD STE A
Elkhart, IN 46514
(574) 295-1131
✔ PECOS✔ Accepts Medicare0.5 mi
Jerald Hochstetler, MD
Urology
NPI 1164401469
1506 OSOLO ROAD STE A
Elkhart, IN 46514
(574) 295-1131
✔ PECOS✔ Accepts Medicare0.5 mi
Sunny Johnson, FNP-BC
Nurse Practitioner
NPI 1114564762
1506 OSOLO ROAD STE A
Elkhart, IN 46514
(574) 295-1131
✔ PECOS✔ Accepts Medicare0.5 mi
Anish Nayee, MD
Urology
NPI 1417936725
1506 OSOLO ROAD STE A
Elkhart, IN 46514
(574) 295-1131
✔ PECOS✔ Accepts Medicare0.5 mi
Lyn Stevens, NP
Nurse Practitioner
NPI 1558357749
1506 OSOLO ROAD STE A
Elkhart, IN 46514
(574) 295-1131
✔ PECOS✔ Accepts Medicare0.5 mi
Lindsay Vasil, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1093169096
1513 E JACKSON BLVD
Elkhart, IN 46516
(574) 523-3193
✔ Accepts Medicare0.6 mi
Tamara Riess, NP
Nurse Practitioner
NPI 1144281130
525 W BRISTOL ST
Elkhart, IN 46514
(574) 262-0239
✔ PECOS✔ Accepts Medicare0.9 mi
Carrie Daniels, FNP
Nurse Practitioner
NPI 1104225739
3301 COUNTY ROAD 6 E
Elkhart, IN 46514
(574) 264-9635
✔ PECOS✔ Accepts Medicare1.4 mi
David Dyck, MD
Family Practice
NPI 1053303479
3301 COUNTY ROAD 6 E
Elkhart, IN 46514
(574) 264-9635
✔ PECOS✔ Accepts Medicare1.4 mi
Israr Siddiqi, M.D.
Internal Medicine
NPI 1346289501
525 W BRISTOL ST
Elkhart, IN 46514
(574) 262-0329
✔ PECOS✔ Accepts Medicare1.6 mi
Edwin Annan, MD
Pulmonary Disease
NPI 1528245040
500 ARCADE AVE STE 210
Elkhart, IN 46514
(574) 389-5656
✔ PECOS✔ Accepts Medicare2.5 mi
Abuzafar Arif, M.D.
Gastroenterology
NPI 1447253539
500 ARCADE AVE STE 300
Elkhart, IN 46514
(574) 389-7362
✔ PECOS✔ Accepts Medicare2.5 mi
Colin Fath, M.D.
General Surgery
NPI 1811300817
500 ARCADE AVE STE 320
Elkhart, IN 46514
(574) 523-7900
✔ PECOS2.5 mi
Dennis Fitzpatrick, MD
Anesthesiology
NPI 1831180306
500 ARCADE AVE STE 210
Elkhart, IN 46514
(574) 389-5656
✔ PECOS✔ Accepts Medicare2.5 mi
Walter Halloran, MD
Thoracic Surgery
NPI 1053486191
500 ARCADE AVE STE 230
Elkhart, IN 46514
(574) 522-6565
✔ PECOS✔ Accepts Medicare2.5 mi
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 15D2019223

Beacon Medical Group Pediatrics Goshen · Goshen, IN
Active · expires Jul 6, 2028
CLIA Number15D2019223
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2026
Certificate Expiration DateJuly 6, 2028
Laboratory DirectorDr. Andrew G. Lapadat
Laboratory Phone(574) 262-0313
Laboratory LocationBeacon Medical Group Pediatrics Goshen2606 Peddlers Village Rd, Ste 218, Goshen, IN 46526
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 1861816761. It was assigned to this organization in the NPPES registry on February 12, 2014. The provider is doing business as Beacon Medical Group Pediatrics Bristol Street, Beacon Medical Group Pediatrics Goshen and Beacon Medical Group Pediatrics Rieth Blvd.

Where is Beacon Medical Group, Inc. located?

Beacon Medical Group, Inc. is located at 1627 E Bristol St, Elkhart, IN 46514. The listed phone number is (574) 262-0313.

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, 4 practice at this address and 175 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 15D2019223) is associated with this NPI, valid through July 6, 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 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 August 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.