OrganizationActive
Beacon Medical Group, Inc.
NPI 1518302264 · Adult Health Nurse Practitioner · South Bend, IN
Provider details
- NPI number
- 1518302264
- Entity type
- Organization
- Primary specialty
- Adult Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Jeffrey Costello, Cfo(574) 647-3549
- License
- 71001587A (IN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(78/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
621 Memorial Dr
Suite 602
South Bend, IN 46601-1063
Phone: (574) 647-7413
Fax: (574) 647-2471
Approximate (ZIP-level) locationGet directions
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Other names (DBA / former)
- Doing business as
- Memorial Pain Management
Registry dates
- Enumerated
- 2013-05-08
- Last updated
- 2016-08-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.