NPIMap

Organization Active NPI

Self Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Greenwood, SC
National Provider Identifier
1134442890
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SELF MEDICAL GROUP
Practice address
115 Academy Avenue
Unit a
Greenwood, SC 29646
Phone
(864) 725-7272
Fax
(864) 725-5764
NPI assigned
Mar 10, 2010
Reactivated
Sep 11, 2013
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, MD
Title
President and Ceo
Phone
(864) 725-4253

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

115 Academy Avenue
Unit a
Greenwood, SC 29646

Mailing address

115 Academy Avenue
Unit a
Greenwood, SC 29646
Phone (864) 725-7272

Other identifiers 1

IdentifierTypeStateIssuer
GP5374MedicaidSC

Other names 1

  • South Carolina Spine Associates, A Division of SMG 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

Locations

115 Academy Ave
#A
Greenwood, SC 29646
Phone (864) 725-7272

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1134442890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ACADEMY AVENUE",
            "address_2": "UNIT A",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "29646",
            "telephone_number": "864-725-7272",
            "fax_number": "864-725-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ACADEMY AVENUE",
            "address_2": "UNIT A",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "29646",
            "telephone_number": "864-725-7272",
            "fax_number": "864-725-5764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-10",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "deactivation_date": "2012-05-22",
        "reactivation_date": "2013-09-11",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5374",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Carolina Spine Associates, A Division of SMG",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "South Carolina Spine Associates, A Division of SMG",
            "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.