NPI 1548415474 · live from the CMS NPI Registry
Beacon Medical Group, INC.
Pediatrics in South Bend, IN. National Provider Identifier 1548415474, active.
NPI record
| NPI | 1548415474 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics 208000000X |
| Practice location | 100 Navarre Pl Ste 5550, South Bend, IN 46601 |
| Practice phone | 574-647-2550 |
| Mailing address | 3245 Health Dr Ste 100, Granger, IN 46530 |
| Enumerated | November 19, 2008 |
| Last updated | July 21, 2025 |
| Authorized official | Jeffrey Costello, Vice President/Cfo |
| Other names | Beacon Medical Group Pediatric Multi-Specialty; Beacon Medical Group Pediatric Specialists |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist | 103T00000X | — |
| Psychologist, Clinical | 103TC0700X | — |
| Dietitian, Registered | 133V00000X | — |
| Pediatrics, Neonatal-Perinatal Medicine | 2080N0001X | — |
| Pediatrics, Pediatric Pulmonology | 2080P0214X | — |
| Nurse Practitioner | 363L00000X | — |
| Pediatrics primary | 208000000X | 01065535A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.