NPIMap

Organization Active NPI

Self Regional Healthcare Partners

Doing business as Self Medical Center Johnston

  • Rural Health Clinic/Center
  • Johnston, SC
National Provider Identifier
1205723194
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SELF REGIONAL HEALTHCARE PARTNERS
Doing business as
Self Medical Center Johnston
Practice address
801 Mobley St
Johnston, SC 29832-1366
Phone
(803) 275-4653
NPI assigned
Jun 23, 2025
Last updated
Jun 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Matthew Tolbert Logan, MDNPI 1902868078
Title
President & Ceo
Phone
(864) 725-4780

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

801 Mobley St
Johnston, SC 29832-1366

Mailing address

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

Other names 1

  • Self Medical Center Johnston Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251104000839 SC Part A Provider - Rural Health Clinic 1557606118 Practice locations: Johnston, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205723194. Details of each certification follow.

Rural health clinic certification: CCN 428515

Legal name
SELF REGIONAL HEALTHCARE PARTNERS
Doing business as
SELF MEDICAL CENTER JOHNSTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 11, 2026
Last certification
Mar 11, 2026
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
801 Mobley St
Johnston, SC 29832-1366
Related CCNs
421304

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Self Regional Healthcare Partners5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Matthew T Logan Individual Corporate OfficerPresident & Ceo Dec 21, 2021
W-2 Managing EmployeePresident & Ceo Dec 21, 2021
Self Regional Healthcare Organization, Greenwood, SC Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
Clint J Stewart Individual Corporate OfficerVP & Cfo Oct 21, 2024
W-2 Managing EmployeeVP & Cfo Oct 21, 2024

Owners & managing parties with NPI records 17

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 17

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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": "1750636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1205723194",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MOBLEY ST",
            "city": "JOHNSTON",
            "state": "SC",
            "postal_code": "298321366",
            "telephone_number": "803-275-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REGIONAL HEALTHCARE PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-23",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "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",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Self Medical Center Johnston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnston, SC

Sources for this page

Verify at the official NPI Registry.