BEACON MEDICAL GROUP- TRAUMA AND SURGICAL SERVICES – NPI #1174927131
Surgery

Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency.

BEACON MEDICAL GROUP- TRAUMA AND SURGICAL SERVICES is a surgeon located in SOUTH BEND, IN. NPPES has assigned the NPI number 1174927131 to BEACON MEDICAL GROUP- TRAUMA AND SURGICAL SERVICES on October 20, 2014. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “BEACON MEDICAL GROUP- TRAUMA AND SURGICAL SERVICES” 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 2086S0127X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Trauma Surgery

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- TRAUMA AND SURGICAL SERVICES below.

NPI Profile for
BEACON MEDICAL GROUP, INC.

NPI Number
1174927131
Enumeration Date

(more than 11 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- TRAUMA AND SURGICAL SERVICES
Primary location
621 MEMORIAL DR STE 502
SOUTH BEND, IN 46601-1075
Phone: (574) 647-5875 Fax: (574) 647-5878
Mailing address
710 N NILES AVE
SOUTH BEND, IN 46617-1924
Phone: (574) 647-1610 Fax: (574) 237-6069
Organization Subpart
No
Authorized Official
JEFFREY COSTELLO
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- TRAUMA AND SURGICAL SERVICES

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
medicaidIN200921930E
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
2086S0127X
- Surgery / Trauma Surgery (Primary)
2086S0129X
- Surgery / Vascular Surgery
208600000X
- Surgery

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.