Self Medical Group

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

SELF MEDICAL GROUP

Practice address

109 Liner Dr
Greenwood, SC 29646-2311

Phone

(864) 227-6401

Fax

(864) 941-4995

NPI assigned

Aug 27, 2010

Reactivated

Jun 6, 2019

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

• Urological Services of Self Medical Group Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

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

• Brittney Biere, AU.D., CCC-A

  • Audiologist
  • Greenwood, SC
  • NPI 1902644677
  NPD
• John J Britton Jr., M. D.

  • Urology Physician
  • Charleston, SC
  • NPI 1356394126
  NPD
• Orr McClentic Cobb Jr., M.D.

  • Internal Medicine Physician
  • Greenwood, SC
  • NPI 1952397085
  NPD
• Bryan K Ellenberg, MD

  • Family Medicine Physician
  • Greenwood, SC
  • NPI 1922092345
  NPD
• Latoya D Gibson

  • Adult Health Nurse Practitioner
  • Greenville, SC
  • NPI 1841898038
  NPD
• Todd C Hansen, M.D.

  • Urology Physician
  • Greenwood, SC
  • NPI 1245293455
  NPD
• Ashleigh Wilson Leopard, APRN

  • Family Nurse Practitioner
  • Greenwood, SC
  • NPI 1104277425
  NPD
• Anthony R Timms, MD

  • Orthopaedic Surgery Physician
  • Greenwood, SC
  • NPI 1083719009
  NPD
• Case McKinley Wood, MD

  • Urology Physician
  • Charleston, SC
  • NPI 1316305881
  NPD
• Joseph D Conti, MD

  • Urology Physician
  • Indiana, PA
  • NPI 1073585089
  NPD
• Margot Alexandra Wacks, D.O.

  • Obstetrics & Gynecology Physician
  • Ocala, FL
  • NPI 1114293172
  NPD

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1871809855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 LINER DR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462311",
            "telephone_number": "864-227-6401",
            "fax_number": "864-941-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 LINER DR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462311",
            "telephone_number": "864-227-6401",
            "fax_number": "864-941-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-27",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "deactivation_date": "2012-05-22",
        "reactivation_date": "2019-06-06",
        "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": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urological Services 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

• Urology Physician in Greenwood, SC
• Providers in Greenwood, SC by specialty
• Urology 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.