Self Medical Group

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

SELF MEDICAL GROUP

Practice address

1029A Edgefield St
Greenwood, SC 29646-3205

Phone

(864) 388-2122

Fax

(864) 388-7948

NPI assigned

Nov 3, 2022

Last updated

Nov 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matthew T Logan

Title

President and Ceo

Phone

(864) 725-4253

Specialties & licenses 1

Addresses

Other names 1

• Advanced Obstetrics and Gynecology Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Heather Hendrix Armstrong, AU.D.

  • Audiologist
  • Greenwood, SC
  • NPI 1194909333
  NPD
• Robert L Brun, PA

  • Physician Assistant
  • Greenwood, SC
  • NPI 1134407398
  NPD
• Casey Long, PA-C

  • Physician Assistant
  • Greenwood, SC
  • NPI 1548939796
  NPD
• Ty Smith, PA

  • Physician Assistant
  • Albemarle, NC
  • NPI 1811769599
  NPD

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

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1144937608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029A EDGEFIELD ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463205",
            "telephone_number": "864-388-2122",
            "fax_number": "864-388-7948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029A EDGEFIELD ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463205",
            "telephone_number": "864-388-2122",
            "fax_number": "864-388-7948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "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"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Obstetrics and Gynecology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Self Medical Group
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• Self Medical Group
• Self Medical Group
• Self Medical Group
• Self Medical Group
• Self Medical Group

• Obstetrics & Gynecology Physician in Greenwood, SC
• Providers in Greenwood, SC by specialty
• Obstetrics & Gynecology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.