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 provides Family Medicine Physician services 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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