MEDICARE: BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1518489921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON ORTHOPAEDICS & SPORTS MEDICINE, LTD

Provider Business Mailing Address
First Line	:	6480 HARRISON AVE STE 201
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7961
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-354-7661

Provider Business Practice Location Address
First Line	:	2835 MIAMI VILLAGE DR
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-4587
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-354-7661

Authorized Official
Title or Position	:	CEO
Name	:	TIMOTHY YUCKMAN
Credential	:
Telephone Number	:	513-354-7785

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/23/2025

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