NPIMap

Organization Active NPI

Self Medical Group

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Greenwood, SC
National Provider Identifier
1538488457
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
SELF MEDICAL GROUP
Practice address
1506 Spring St
Greenwood, SC 29646-4071
Phone
(864) 725-7900
Fax
(864) 725-7910
NPI assigned
May 18, 2010
Last updated
May 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X Primary

Addresses

Primary practice location

1506 Spring St
Greenwood, SC 29646-4071

Mailing address

105 Vinecrest CT # 500
Greenwood, SC 29646-8031
Phone (864) 725-7900

Other names 1

  • Advanced Cardiothoracic Surgery, A Division 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

1506 Spring St
Greenwood, SC 29646
Phone (864) 227-3117

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1538488457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 VINECREST CT # 500",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296468031",
            "telephone_number": "864-725-7900",
            "fax_number": "864-725-7910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464071",
            "telephone_number": "864-725-7900",
            "fax_number": "864-725-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-18",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Cardiothoracic Surgery, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Advanced Cardiothoracic Surgery, A Division 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 May 31, 2024; 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.