MEDICARE: BEACON MEDICAL GROUP, INC.

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	363LF0000X	Family Nurse Practitioner
2	170300000X	Genetic Counselor (M.S.)
3	207V00000X	Obstetrics & Gynecology Physician
4	2086S0102X	Surgical Critical Care Physician
5	207VM0101X	Maternal & Fetal Medicine Physician	01053966A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710939608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NAVARRE PL STE 4410
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1171
Country	:	US
Telephone Number	:	574-647-6370
Fax Number	:	574-647-6373

Authorized Official
Title or Position	:	VP-CFO
Name	:	JEFFREY COSTELLO
Credential	:
Telephone Number	:	574-647-3549

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/10/2026

Similar Medicare Providers

1083545859 — GLORIA SUE HOFFMAN
Practice Location Address:

100 NAVARRE PL STE 4410
SOUTH BEND, IN
46601-1171

Practice Phone: 574-647-6370
Practice Fax: 574-647-6373

1780098780 — CHRISTOPHER FREDERICK KETCHAM DO
Practice Location Address:

100 NAVARRE PL STE 4440
SOUTH BEND, IN
46601-1171

Practice Phone: 574-647-5300
Practice Fax: 574-647-5305

1225026669 — DR. WILLIE LEE DONALD M.D.
Practice Location Address:

100 NAVARRE PL STE 4410
SOUTH BEND, IN
46601-1171

Practice Phone: 574-647-1650
Practice Fax: 574-647-1655

1447203674 — BEACON MEDICAL GROUP, INC.
Practice Location Address:

100 NAVARRE PL STE 4440
SOUTH BEND, IN
46601-1171

Practice Phone: 574-647-4540
Practice Fax: 574-647-4542

1598798779 — DR. MICAELA DELLA TORRE M.D.
Practice Location Address:

100 NAVARRE PL STE 4410
SOUTH BEND, IN
46601-1171

Practice Phone: 574-647-1650
Practice Fax:

1427150796 — KEVIN C ANDERSON MD
Practice Location Address:

100 NAVARRE PL STE 4440
SOUTH BEND, IN
46601-1171

Practice Phone: 574-647-5300
Practice Fax: 574-647-5305

Directions to “BEACON MEDICAL GROUP, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.