NPIMap

Organization Active NPI

Self Medical Group

  • Family Medicine Physician
  • Greenwood, SC
National Provider Identifier
1487212130
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SELF MEDICAL GROUP
Practice address
105 Vinecrest CT # 510
Greenwood, SC 29646-8031
Phone
(864) 725-4016
Fax
(864) 725-5839
NPI assigned
May 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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 Ceo
Phone
(864) 725-4253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

105 Vinecrest CT # 510
Greenwood, SC 29646-8031

Mailing address

105 Vinecrest CT # 510
Greenwood, SC 29646-8031
Phone (864) 725-4016

Other names 1

  • Ready for Surgery Clinic of Self Medical Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091027000071 SC Part B Supplier - Clinic/Group Practice 6002953916 Receives reassigned benefits from 613 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Saluda, SC; Newberry, SC; Greenwood, SC; Abbeville, SC; Clinton, SC; Greenville, SC

National Provider Directory

National Provider Directory

Locations

105 Vinecrest Ct
Greenwood, SC 29646
Phone (843) 572-4840

Practitioners & affiliated clinicians

Practitioners 9

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": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1487212130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 VINECREST CT # 510",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296468031",
            "telephone_number": "864-725-4016",
            "fax_number": "864-725-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 VINECREST CT # 510",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296468031",
            "telephone_number": "864-725-4016",
            "fax_number": "864-725-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "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.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ready for Surgery Clinic of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

  • 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.