Self Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SELF MEDICAL GROUP

Practice address

110 Highway 246 N
Greenwood, SC 29649-8748

Phone

(864) 725-1750

Fax

(864) 725-1762

NPI assigned

Sep 15, 2017

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 1

Addresses

Other names 1

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

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa Calderon, DNP APRN FNP-C

  • Family Nurse Practitioner
  • Greenwood, SC
  • NPI 1083965347
  NPD
• Brian Michael Goodman, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Greenwood, SC
  • NPI 1740453893
  NPD
• Gary Dallas Morrison II, PA

  • Physician Assistant
  • Greenwood, SC
  • NPI 1942472634
  NPD
• Dillard W Stephens, DO

  • Family Medicine Physician
  • Laurens, SC
  • NPI 1902302516
  NPD
• Clay Watson

  • Physician Assistant
  • Greenwood, SC
  • NPI 1912661307
  NPD

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750800264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HIGHWAY 246 N",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296498748",
            "telephone_number": "864-725-1750",
            "fax_number": "864-725-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HIGHWAY 246 N",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296498748",
            "telephone_number": "864-725-1750",
            "fax_number": "864-725-1762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Highway 246 N",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296498748",
            "country_code": "US",
            "telephone_number": "864-725-1750",
            "fax_number": "864-725-1763",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 Highway 246 N",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296498748",
            "country_code": "US",
            "telephone_number": "864-725-7491",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2022-07-21",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Healthcare Coronaca, A Division of Self Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Family Healthcare Coronaca, 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

• Family Medicine Physician in Greenwood, SC
• Providers in Greenwood, 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 Jul 21, 2022; 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.