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 1629376645

Beacon Medical Group, Inc is a Family Medicine Physician in South Bend, Indiana. Licensed in Indiana. Registered with an NPI since 2011.

Licensed in
IN
In the registry since
2011
Specialties on file
5
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

707 N Michigan St Ste 400
South Bend, IN 46601-1071
Phone: (574) 647-8470
Fax: (574) 647-8475
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 01052982A (IN)
Family Medicine Physician Taxonomy 207Q00000X
Child & Adolescent Psychiatry Physician Taxonomy 2084P0804X · Licence 01052982A (IN)
Geriatric Psychiatry Physician Taxonomy 2084P0805X · Licence 01052982A (IN)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X

Record details

NPI number1629376645
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Costello — Vp/Cfo · (574) 647-3549
Other names Beacon Medical Group Behavioral Health South Bend; Beacon Medical Group Behavioral Health South Bend
NPI enumeratedMarch 1, 2011
Last updated in NPPESFebruary 22, 2024
Certification dateFebruary 22, 2024
Mailing address710 N Niles Ave, South Bend, IN 46617-1924

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