BEACON MEDICAL GROUP MAIN STREET – NPI #1053361543
Family Medicine

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

BEACON MEDICAL GROUP MAIN STREET is a provider located in GRANGER, IN. NPPES has assigned the NPI number 1053361543 to BEACON MEDICAL GROUP MAIN STREET on May 12, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “BEACON MEDICAL GROUP MAIN STREET” is a dba name, the actual legal business name for this organization is BEACON MEDICAL GROUP, INC.. This provider is also associated with 2 additional names listed below. According to the NPI data, there are 2 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207Q00000X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine. Bear in mind that having a taxonomy code selected doesn't replace any credentialing or validation process that may be required by law.

The NPI profile was last updated on Aug 26, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for BEACON MEDICAL GROUP MAIN STREET below.

NPI Profile for
BEACON MEDICAL GROUP, INC.

NPI Number
1053361543
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
BEACON MEDICAL GROUP, INC.
Doing Business As (dba): BEACON MEDICAL GROUP MAIN STREET
Other name(s)
All associated names:
Doing Business As (dba)
BEACON MEDICAL GROUP MAIN STREET
Doing Business As (dba)
Beacon Medical Group Pediatrics Main Street
Primary location
6913 N MAIN ST STE 300
GRANGER, IN 46530-8039
Phone: (574) 647-1500 Fax: (574) 647-2567
2 Other location(s):
6901 N Main St Ste 102
Granger, IN 46530-8022
Phone: (574) 647-4500
Fax: (574) 647-6354
6913 N Main St Ste 200
Granger, IN 46530-8039
Phone: (574) 647-2567
Fax: (574) 647-2971
Mailing address
3245 HEALTH DR STE 100
GRANGER, IN 46530-1380
Phone: Fax:
Organization Subpart
No
Authorized Official
JEFFREY COSTELLO
VP-CFO
Phone: (574) 647-3549
Updated
Certification Date
Aug 26, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for BEACON MEDICAL GROUP MAIN STREET

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidIN300002852
medicaidIN300015362
medicaidIN100224050C
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.