Self Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SELF MEDICAL GROUP

Practice address

1228 Highway 72 W
Greenwood, SC 29649-1816

Phone

(864) 943-0549

NPI assigned

Apr 22, 2015

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

Title

President and Ceo

Phone

(864) 725-4253

Specialties & licenses 1

Addresses

Other names 1

• Family Healthcare West Greenwood, A Division of Self Medical Group 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

Practitioners 5

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

• Leonard Cheung Lim, M.D.

  • Pulmonary Disease Physician
  • Greenwood, SC
  • NPI 1104106368
  NPD
• Joanna K Metzner - Sadurski, MD

  • Hematology & Oncology Physician
  • Greenwood, SC
  • NPI 1801807011
  NPD
• Robert J Tiller, MD

  • Family Medicine Physician
  • Greenwood, SC
  • NPI 1235156233
  NPD
• Paul J Velky, MD

  • Anesthesiology Physician
  • Greenwood, SC
  • NPI 1437139235
  NPD
• Gordon R Wagler, MD

  • Internal Medicine Physician
  • Greenwood, SC
  • NPI 1144780958
  NPD

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

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1376930875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 HIGHWAY 72 W",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296491816",
            "telephone_number": "864-943-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 HIGHWAY 72 W",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296491816",
            "telephone_number": "864-943-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "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 CEO",
        "authorized_official_telephone_number": "864-725-4253",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Healthcare West Greenwood, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Family Healthcare West Greenwood, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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

• Family Medicine Physician in Greenwood, SC
• Providers in Greenwood, SC by specialty
• Family 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.
• 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.