OrganizationActive
Beacon Medical Group, Inc.
NPI 1710939608 · Maternal & Fetal Medicine Physician · South Bend, IN
Provider details
- NPI number
- 1710939608
- Entity type
- Organization
- Primary specialty
- Maternal & Fetal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jeffrey Costello, Vp-Cfo(574) 647-3549
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Nurse Practitioner363LF0000X
Physician Assistants & Advanced Practice Nursing Providers
- Genetic Counselor (M.S.)170300000X
Other Service Providers
- Obstetrics & Gynecology Physician207V00000X
Allopathic & Osteopathic Physicians
- Surgical Critical Care Physician2086S0102X
Allopathic & Osteopathic Physicians
Practice location
100 Navarre Pl Ste 4410
South Bend, IN 46601-1171
Phone: (574) 647-6370
Fax: (574) 647-6373
Approximate (ZIP-level) locationGet directions
Mailing address
3245 Health Dr Ste 100
Granger, IN 46530-1380
Other names (DBA / former)
- Doing business as
- Beacon Medical Group Maternal Fetal Medicine South Bend
Registry dates
- Enumerated
- 2006-05-17
- Last updated
- 2026-02-10
- Certified
- 2026-02-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.