Self Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SELF MEDICAL GROUP

Practice address

103 Little Mountain Rd
Ninety Six, SC 29666-9252

Phone

(864) 543-3515

NPI assigned

Apr 14, 2015

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

Title

President and Ceo

Phone

(864) 725-4253

Specialties & licenses 1

Addresses

Other names 1

• Family Healthcare Ninety Six, A Division of Self Medical Group Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 5

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.

• Joy C Dunlap, PA

  • Physician Assistant
  • Greenwood, SC
  • NPI 1225430747
  NPD
• Todd A Gallman, MD

  • Family Medicine Physician
  • Greenwood, SC
  • NPI 1962498998
  NPD
• Elizabeth Hammond, C.P.N.P.

  • Pediatric Nurse Practitioner
  • Greenwood, SC
  • NPI 1508870635
  NPD
• Michael P.B. Kilburn, MD

  • Neurological Surgery Physician
  • Greenwood, SC
  • NPI 1992884753
  NPD
• Stanley G Walsh, MD

  • Family Medicine Physician
  • Laurens, SC
  • NPI 1891738423
  NPD

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

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1609262807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 LITTLE MOUNTAIN RD",
            "city": "NINETY SIX",
            "state": "SC",
            "postal_code": "296669252",
            "telephone_number": "864-543-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 LITTLE MOUNTAIN RD",
            "city": "NINETY SIX",
            "state": "SC",
            "postal_code": "296669252",
            "telephone_number": "864-543-3515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-14",
        "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": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Healthcare Ninety Six, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Family Healthcare Ninety Six, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Swetha Narala, MD
• Ninety Six Pharmacy, Inc. (Family Pharmacy)
• Andrew Collier Owings, DMD
• Dharmendrakumar B Patel, PHARM D.
• Mary Pippin, RN
• Self Regional Healthcare (Family Healthcare Ninety Six)
• Self Regional Healthcare (Family Healthcare Ninety Six)
• Dora Smith
• Songbird Therapy, LLC
• Stephen Spearman

• Family Medicine Physician in Ninety Six, SC
• Providers in Ninety Six, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.