NPIMap

Organization Active NPI

Self Regional Healthcare

  • Urgent Care Clinic/Center
  • Greenwood, SC
National Provider Identifier
1053110312
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SELF REGIONAL HEALTHCARE
Practice address
102 Rockcreek Blvd
Greenwood, SC 29649-8915
Phone
(864) 725-5020
Fax
(864) 725-5615
NPI assigned
Mar 10, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Authorized official

Name
Matthew Tolbert Logan
Title
President & Ceo
Phone
(864) 725-4780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

102 Rockcreek Blvd
Greenwood, SC 29649-8915

Mailing address

104 Wells Ave
Greenwood, SC 29646-3837
Phone (864) 725-4673

Other names 1

  • Urgent Care Greenwood Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051214000767 SC Part B Supplier - Clinic/Group Practice 4082527742 Receives reassigned benefits from 234 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenwood, SC; Clinton, SC; Ware Shoals, SC; Saluda, SC; Ninety Six, SC; Newberry, SC; MC Cormick, SC; Laurens, SC…

National Provider Directory

National Provider Directory
Tax ID family
Western Carolina Psych47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1741564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764547200000",
    "number": "1053110312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463837",
            "telephone_number": "864-725-4673",
            "fax_number": "864-725-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ROCKCREEK BLVD",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296498915",
            "telephone_number": "864-725-5020",
            "fax_number": "864-725-5615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REGIONAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-10",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TOLBERT",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "864-725-4780"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urgent Care Greenwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 1, 2025; 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.