Self Medical Group

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SELF MEDICAL GROUP

Practice address

210 Wells Ave
Greenwood, SC 29646-3843

Phone

(864) 943-4279

Fax

(864) 223-2642

NPI assigned

Apr 22, 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, MD

Title

President and Ceo

Phone

(864) 725-4253

Specialties & licenses 4

Addresses

Other names 1

• Pediatric Associates Greenwood, A Division of Self Medical Group Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 6

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.

• William G Devore, MD

  • Anesthesiology Physician
  • Greenwood, SC
  • NPI 1265429930
  NPD
• Steve Woo Chul Han, MD

  • Internal Medicine Physician
  • Easley, SC
  • NPI 1184885121
  NPD
• John A King, MD

  • Orthopaedic Hand Surgery Physician
  • Greenwood, SC
  • NPI 1285739219
  NPD
• Alexandra Landers Lataille, M.D.

  • Anesthesiology Physician
  • Greenwood, SC
  • NPI 1538549639
  NPD
• Miranda Fitzgerald Magee, APRN

  • Family Nurse Practitioner
  • Greenwood, SC
  • NPI 1235885146
  NPD
• Davis Renee Migdalas, FNP

  • Family Nurse Practitioner
  • Abbeville, SC
  • NPI 1376053249
  NPD

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

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1720475221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463843",
            "telephone_number": "864-943-4279",
            "fax_number": "864-223-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463843",
            "telephone_number": "864-943-4279",
            "fax_number": "864-223-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "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": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Associates Greenwood, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pediatric Associates 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 (Advanced Gastroenterology)

• Pediatrics Physician in Greenwood, SC
• Providers in Greenwood, SC by specialty
• Pediatrics 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.