Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Beacon Medical Group, Inc

Organization Family Medicine Physician · NPI 1124079330

Beacon Medical Group, Inc is a Family Medicine Physician in South Bend, Indiana. Works from 2 locations. Licensed in Indiana.

Licensed in
IN
In the registry since
2006
Specialties on file
9
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1815 E Ireland Rd
South Bend, IN 46614-2845
Phone: (574) 647-1700
Fax: (574) 291-3351
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 576 N Oak Dr, Plymouth, IN 46563-1664 — (574) 647-5170

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 01043622A (IN)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X
Internal Medicine Physician Taxonomy 207R00000X
Interventional Cardiology Physician Taxonomy 207RI0011X
Rheumatology Physician Taxonomy 207RR0500X
Neurological Surgery Physician Taxonomy 207T00000X
Diagnostic Ultrasound Physician Taxonomy 2085U0001X
Physician Assistant Taxonomy 363A00000X
Family Nurse Practitioner Taxonomy 363LF0000X

Record details

NPI number1124079330
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Costello — Vp-Cfo · (574) 647-3549
Other names Beacon Medical Group Ireland Road; Beacon Medical Group Ireland Road; Beacon Medical Group Plymouth
NPI enumeratedMay 12, 2006
Last updated in NPPESJune 25, 2026
Certification dateJune 25, 2026
Mailing address3245 Health Dr Ste 100, Granger, IN 46530-1380

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