NPIMap

Organization Active NPI

Self Medical Group

  • Anesthesiology Physician
  • Greenwood, SC
National Provider Identifier
1013579259
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SELF MEDICAL GROUP
Practice address
1325 Spring St
Greenwood, SC 29646-3860
Phone
(864) 725-4111
Fax
(864) 725-7498
NPI assigned
Jul 8, 2019
Last updated
Dec 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew T Logan, MDNPI 1902868078
Title
President and Ceo
Phone
(864) 725-4253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1325 Spring St
Greenwood, SC 29646-3860

Mailing address

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

Other names 1

  • Anesthesiology Services of Self Medical Group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091027000071 SC Part B Supplier - Clinic/Group Practice 6002953916 Receives reassigned benefits from 613 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Saluda, SC; Newberry, SC; Greenwood, SC; Abbeville, SC; Clinton, SC; Greenville, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 55

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1013579259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111",
            "fax_number": "864-725-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111",
            "fax_number": "864-725-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-08",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "864-725-4253",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anesthesiology Services of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Anesthesiology Services of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.