BEACON MEDICAL GROUP ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND – NPI #1780859157
Internal Medicine

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

BEACON MEDICAL GROUP ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND is a provider located in SOUTH BEND, IN. NPPES has assigned the NPI number 1780859157 to BEACON MEDICAL GROUP ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND on April 28, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “BEACON MEDICAL GROUP ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND” is a dba name, the actual legal business name for this organization is BEACON MEDICAL GROUP, INC.. The primary taxonomy selected by this provider is 207RC0000X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Cardiovascular Disease

The NPI profile was previously updated about 3 years ago on Apr 24, 2023. 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 ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND below.

NPI Profile for
BEACON MEDICAL GROUP, INC.

NPI Number
1780859157
Enumeration Date

(more than 18 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 ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND
Primary location
610 N MICHIGAN ST STE 400
SOUTH BEND, IN 46601-1081
Phone: (574) 647-8120 Fax: (574) 647-8111
Mailing address
710 N NILES AVE
SOUTH BEND, IN 46617-1924
Phone: (574) 647-1610 Fax:
Organization Subpart
No
Authorized Official
JEFFREY COSTELLO
VP/CFO
Phone: (574) 647-3549
Updated
Certification Date
Apr 24, 2023

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 ADVANCED CARDIOLOGY SPECIALISTS SOUTH BEND

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
medicaidIN200921930A
medicaidIN200921930D
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.

Taxonomy Classification / Specialization State License
207RC0000X
- Internal Medicine / Cardiovascular Disease (Primary)
IN 01045628A

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.