{"npi":"1932468352","type":"NPI-2","status":"active","name":{"display":"Beacon Medical Group, Inc.","other":[],"organization_name":"BEACON MEDICAL GROUP, INC.","authorised_official":"Jeffrey Costello"},"specialty":{"primary_taxonomy":"2085R0204X","primary_taxonomy_description":"Vascular & Interventional Radiology Physician","slug":"vascular-interventional-radiology-physician","schema_org_specialty":null,"all":[{"code":"2085R0204X","description":"Vascular & Interventional Radiology Physician","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"621 MEMORIAL DR STE 312","city":"SOUTH BEND","state":"IN","postal_code":"466011073","country_code":"US","phone":"5746475200","fax":"5746475210"},{"purpose":"MAILING","street_1":"710 N NILES AVE","city":"SOUTH BEND","state":"IN","postal_code":"466171924","country_code":"US","phone":"5746471610"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"201063130A","state":"IN","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2012-05-04","last_updated":"2017-10-12","_meta":{"source":"NPPES","snapshot_date":"2017-10-12","doc_url":"https://findmynpi.com/api"}}