NPIMap

Organization Active NPI

Self Regional Healthcare

Doing business as Self Medical Center Newberry

  • Rural Health Clinic/Center
  • Newberry, SC
National Provider Identifier
1417755265
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SELF REGIONAL HEALTHCARE
Doing business as
Self Medical Center Newberry
Practice address
2605 Kinard St Ste 200a
Newberry, SC 29108-2965
Phone
(803) 405-1900
Fax
(803) 405-1919
NPI assigned
Mar 6, 2025
Last updated
Jul 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2605 Kinard St Ste 200a
Newberry, SC 29108-2965

Mailing address

104 Wells Ave
Greenwood, SC 29646-3837
Phone (864) 725-4673

Other names 1

  • Self Medical Center Newberry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250725003276 SC Part A Provider - Rural Health Clinic 4082527742 Practice locations: Newberry, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417755265. Details of each certification follow.

Rural health clinic certification: CCN 428503

Legal name
SELF REGIONAL HEALTHCARE
Doing business as
SELF MEDICAL CENTER NEWBERRY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 10, 2025
Last certification
Oct 10, 2025
Ownership / control type
2B
Organization structure
OtherProprietary
Enrollment address
2605 Kinard St
Ste 200a
Newberry, SC 29108-2965
Related CCNs
420071

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Lawrence B Beasley MD49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Ownership & related parties

All disclosed owners & managing parties 2

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
Clint J Stewart Individual Corporate OfficerVP & Cfo Oct 21, 2024
W-2 Managing EmployeeVP & Cfo Oct 21, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Self Regional HealthcareGreenwood, SC, CCN 420071 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2025
Abbeville Area Medical CenterAbbeville, SC, CCN 421301 Hospital Operational/Managerial Control (100%) Oct 1, 2023
Edgefield County Healthcare an Affiliate of Self Regional HealthcareEdgefield, SC, CCN 421304 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Self Regional Healthcare PartnersEdgefield, SC, CCN 42Z304 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Abbeville Hospital Swingbed UnitAbbeville, SC, CCN 42Z301 Hospital Operational/Managerial Control (100%) Oct 1, 2023
Abbeville Area Healthcare CenterAbbeville, SC, CCN 423451 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2023
Due West Family MedicineDue West, SC, CCN 423453 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2023
Edgefield Medical CenterEdgefield, SC, CCN 423436 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Family Healthcare North SaludaSaluda, SC, CCN 873806 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 27, 2009
Self Medical Center JohnstonJohnston, SC, CCN 428515 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1417755265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463837",
            "telephone_number": "864-725-4673",
            "fax_number": "864-725-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 KINARD ST STE 200A",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082965",
            "telephone_number": "803-405-1900",
            "fax_number": "803-405-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REGIONAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "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"
    },
    "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 Newberry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newberry, SC

Sources for this page

Verify at the official NPI Registry.