Self Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SELF MEDICAL GROUP

Practice address

115 Overland Drive
Greenwood, SC 29646-4053

Phone

(864) 227-6641

Fax

(864) 227-3953

NPI assigned

Apr 8, 2011

Last updated

Dec 14, 2021By 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

Dr. Matthew T Logan, MD

Title

President and Chief Executive Offic

Phone

(864) 725-4253

Specialties & licenses 1

Addresses

Other names 1

• Internal Medicine of Greenwood a division of Self Medical Group Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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.

• Kelly Addy, NP

  • Family Nurse Practitioner
  • Greenwood, SC
  • NPI 1790215291
  NPD
• Stephen Andrew Boucher, APRN

  • Nurse Practitioner
  • Greenwood, SC
  • NPI 1730728031
  NPD
• Sumeer Lal, MD

  • Neurological Surgery Physician
  • Greenwood, SC
  • NPI 1588743330
  NPD
• Joseph Williamson III, PA-C

  • Physician Assistant
  • Greer, SC
  • NPI 1326849407
  NPD

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

{
    "created_epoch": "1302220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1407146715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 OVERLAND DRIVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464053",
            "telephone_number": "864-227-6641",
            "fax_number": "864-227-3953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 OVERLAND DRIVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464053",
            "telephone_number": "864-227-6641",
            "fax_number": "864-227-3953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-08",
        "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": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medicine of Greenwood a division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Internal Medicine of 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

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