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

Beacon Medical Group, Inc

Organization Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · NPI 1881971505

Beacon Medical Group, Inc is a Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in South Bend, Indiana. Registered with an NPI since 2011.

In the registry since
2011
Specialties on file
3
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

610 N Michigan St Ste 306
South Bend, IN 46601-1079
Phone: (574) 647-6500
Fax: (574) 647-6518
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (primary) Taxonomy 208G00000X
Physician Assistant Taxonomy 363A00000X
Family Nurse Practitioner Taxonomy 363LF0000X

Record details

NPI number1881971505
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Costello — Vp/Cfo · (574) 647-3549
Other names Beacon Medical Group Cardiothoracic Surgery South Bend; Beacon Medical Group Cardiothoracic Surgery South Bend
NPI enumeratedNovember 9, 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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