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 1639129117

Beacon Medical Group, Inc provides Family Medicine Physician services in LA Porte, Indiana. Licensed in Indiana. Registered with an NPI since 2006.

Licensed in
IN
In the registry since
2006
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

900 I St
LA Porte, IN 46350-5533
Phone: (219) 324-1700
Fax: (219) 324-1710
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 01056419A (IN)
Obstetrics & Gynecology Physician Taxonomy 207V00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1639129117
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Costello — Vp-Cfo · (574) 647-3549
Other names Beacon Medical Group Laporte; Beacon Medical Group Laporte
NPI enumeratedMay 12, 2006
Last updated in NPPESMarch 4, 2024
Certification dateMarch 4, 2024
Mailing address710 N Niles Ave, South Bend, IN 46617-1924

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