BEACON MEDICAL GROUP INC. NPI 1629376645

NPI Information

  • NPI: 1629376645
  • Provider Name: BEACON MEDICAL GROUP, INC.
  • Classification: Psychiatry & Neurology - 2084P0800X
  • Specialization: Psychiatry
  • Entity Type: Organization
  • Doing Business As: BEACON MEDICAL GROUP BEHAVIORAL HEALTH SOUTH BEND
  • Address: 707 N MICHIGAN ST STE 400
    SOUTH BEND, IN
    ZIP 46601
  • Phone: (574) 647-8470

Map and Directions

Get Directions

NPI Details

BEACON MEDICAL GROUP, INC. is a psychiatry psychiatry neurology in South Bend, IN. The provider is a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. BEACON MEDICAL GROUP, INC. NPI is 1629376645. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Beacon Medical Group Behavioral Health South Bend.

The provider's business location address is:

707 N MICHIGAN ST STE 400
SOUTH BEND, IN
ZIP 46601-071
Phone: (574) 647-8470
Fax: (574) 647-8475

The provider's authorized official is Jeffrey P Costello .
The authorized official title is Vp/cfo and has the following contact phone number (574) 647-3549.

The enumeration date for this NPI number is 3/1/2011 and was last updated on 2/22/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental HealthNo
2207Q00000XFamily MedicineNo
32084P0804XPsychiatry & NeurologyChild & Adolescent Psychiatry01052982AINDIANANo
42084P0805XPsychiatry & NeurologyGeriatric Psychiatry01052982AINDIANANo
52084P0800XPsychiatry & NeurologyPsychiatry01052982AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1201013730AMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI