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

Beacon Medical Group, Inc

Organization Sports Medicine (Family Medicine) Physician · NPI 1578515151

Beacon Medical Group, Inc is a Sports Medicine (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

111 W Jefferson Blvd Ste 100
South Bend, IN 46601-1994
Phone: (574) 647-1669
Fax: (574) 239-6461
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X · Licence 01049328A (IN)

Record details

NPI number1578515151
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Costello — Vp-Cfo · (574) 647-3549
Other names Beacon Medical Group Sports Medicine South Bend
NPI enumeratedMay 16, 2006
Last updated in NPPESAugust 30, 2016
Mailing address710 N Niles Ave, South Bend, IN 46617-1924

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