BEACON MEDICAL GROUP PEDIATRIC HEMATOLOGY ONCOLOGY – NPI #1992756696
Pediatrics

A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases.

BEACON MEDICAL GROUP PEDIATRIC HEMATOLOGY ONCOLOGY is a provider located in SOUTH BEND, IN. NPPES has assigned the NPI number 1992756696 to BEACON MEDICAL GROUP PEDIATRIC HEMATOLOGY ONCOLOGY on May 15, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “BEACON MEDICAL GROUP PEDIATRIC HEMATOLOGY ONCOLOGY” 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 2080P0207X from the Health Care Provider Taxonomy code set, which is classified as Pediatrics, specializing in Pediatric Hematology-Oncology

The NPI profile was previously updated about 2 years ago on Mar 04, 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 PEDIATRIC HEMATOLOGY ONCOLOGY below.

NPI Profile for
BEACON MEDICAL GROUP, INC.

NPI Number
1992756696
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 PEDIATRIC HEMATOLOGY ONCOLOGY
Primary location
615 N MICHIGAN ST 4TH FL
SOUTH BEND, IN 46601-1033
Phone: (574) 647-6892 Fax: (574) 647-6895
Mailing address
710 N NILES AVE
SOUTH BEND, IN 46617-1924
Phone: (574) 647-1610 Fax:
Organization Subpart
No
Authorized Official
JEFFREY COSTELLO
CFO
Phone: (574) 647-3549
Updated
Certification Date
Mar 04, 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 PEDIATRIC HEMATOLOGY ONCOLOGY

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
medicaidIN200510720A
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
2080P0207X
- Pediatrics / Pediatric Hematology-Oncology (Primary)
IN 02001713A

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.