BEACON MEDICAL GROUP SPECIALISTS MAIN SUITE 100 – NPI #1306899554
Internal Medicine

An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

BEACON MEDICAL GROUP SPECIALISTS MAIN SUITE 100 is a provider located in GRANGER, IN. NPPES has assigned the NPI number 1306899554 to BEACON MEDICAL GROUP SPECIALISTS MAIN SUITE 100 on May 18, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “BEACON MEDICAL GROUP SPECIALISTS MAIN SUITE 100” is a dba name, the actual legal business name for this organization is BEACON MEDICAL GROUP, INC.. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RE0101X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism

The NPI profile was previously updated about 6 years ago on Dec 09, 2019. 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 SPECIALISTS MAIN SUITE 100 below.

NPI Profile for
BEACON MEDICAL GROUP, INC.

NPI Number
1306899554
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 SPECIALISTS MAIN SUITE 100
Primary location
6913 N MAIN ST STE 100
GRANGER, IN 46530
Phone: (574) 647-6400 Fax: (574) 647-2951
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
Dec 09, 2019

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 SPECIALISTS MAIN SUITE 100

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
MEDICAIDIN100224050D
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
207RE0101X
- Internal Medicine / Endocrinology, Diabetes & Metabolism (Primary)
207Q00000X
- Family Medicine
207N00000X
- Dermatology

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.