Self Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SELF MEDICAL GROUP

Practice address

22580 Highway 76 E
Suite 200
Laurens, SC 29360-8439

Phone

(864) 833-0055

Fax

(864) 833-4008

NPI assigned

Jun 28, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Matthew T Logan, MD

Title

President and Chief Executive Offic

Phone

(864) 725-4253

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Internal Medical Laurens a division of Self Medical Group Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Self Regional Healthcare

  • Family Medicine Physician
  • Newberry, SC
  • NPI 1548068398

  Member Of

  NPD member

Practitioners 3

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

• Gregory Ryan Hoffman, MD

  • Emergency Medicine Physician
  • Greenville, SC
  • NPI 1922025915
  NPD
• Tammy E Kitchens

  • Diagnostic Radiology Physician
  • Greenwood, SC
  • NPI 1689763708
  NPD
• Kurt R Budelmann, M.D.

  • Internal Medicine Physician
  • Greenville, SC
  • NPI 1295760973

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1104137892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22580 HIGHWAY 76 E",
            "address_2": "SUITE 200",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293608439",
            "telephone_number": "864-833-0055",
            "fax_number": "864-833-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22580 HIGHWAY 76 E",
            "address_2": "SUITE 200",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293608439",
            "telephone_number": "864-833-0055",
            "fax_number": "864-833-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "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 CHIEF EXECUTIVE OFFIC",
        "authorized_official_telephone_number": "864-725-4253",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5453",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medical Laurens a division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Internal Medical Laurens a division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Leon Vance Sanders, PTA/L
• SC Department of Juvenile Justice
• SC Regional Housing Authority No.1
• Scbma
• Jenna Michelle Schreiner, PA-C
• Self Medical Group
• Self Medical Group
• Self Medical Group
• Self Regional Healthcare
• Self Regional Healthcare

• All providers in Laurens, SC
• Internal Medicine Physician in South Carolina

• 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.