Organization
BEACON MEDICAL GROUP, INC.
Active
Other names
Beacon Medical Group Specialists Bremen, Beacon Bone and Joint Specialists, Beacon Medical Group Surgical Services Elkhart, Beacon Medical Group Infectious Disease, Beacon Medical Group Pulmonology and Critical Care South Bend, Beacon Medical Group Specialists Centennial, Beacon Medical Group Hospital Specialties, Beacon Medical Group Interventional Radiology and Vascular Specialists, Beacon Medical Group Rheumatology Goshen, Beacon Medical Group Specialists Goshen, Beacon Medical Group Specialists Granger, Beacon Medical Group ENT and Audiology Elkhart, Beacon Medical Group ENT and Audiology South Bend
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY P. COSTELLO (VP/CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
500 ARCADE AVE STE 320, ELKHART, IN 46514-2477
(574) 523-7900
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207VG0400X
Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
01049858A
IN
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208M00000X
Hospitalist Physician
01049858A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300012878
—
IN
05
—
300013073
—
IN
05
—
300013260
—
IN
05
—
300013675
—
IN
05
—
300068062
—
IN
05
—
300068474
—
IN
05
—
300070471
—
IN
05
—
300093527
—
IN
05
—
300128004
—
IN
Enumeration date
05/06/2009
Last updated
03/31/2026
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