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

Beacon Medical Group, Inc

Organization Family Medicine Physician · NPI 1568413359

Beacon Medical Group, Inc is a Family Medicine Physician in South Bend, Indiana. Licensed in Indiana. Registered with an NPI since 2006.

Licensed in
IN
In the registry since
2006
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

3575 Portage Ave
South Bend, IN 46628-6092
Phone: (574) 647-4530
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 01054535A (IN)

Record details

NPI number1568413359
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Costello — Vp-Cfo · (574) 647-3549
Other names Beacon Medical Group Portage Road
NPI enumeratedMay 15, 2006
Last updated in NPPESSeptember 27, 2013
Mailing address53842 Generations Dr, South Bend, IN 46635-1543

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