NPIMap

Organization Active NPI

Self Regional Healthcare Partners

Doing business as Edgefield County Healthcare, An Affiliate of Self Regional Healthcare

  • Critical Access Hospital
  • Edgefield, SC
National Provider Identifier
1922582105
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
SELF REGIONAL HEALTHCARE PARTNERS
Doing business as
Edgefield County Healthcare, An Affiliate of Self Regional Healthcare
Practice address
300 Ridge Medical Plaza Rd
Edgefield, SC 29824-4525
Phone
(803) 637-3174
Fax
(803) 637-0200
NPI assigned
Sep 24, 2018
Last updated
Dec 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew T Logan, MDNPI 1902868078
Title
President and Ceo
Phone
(864) 725-4253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU
Diagnostic Radiology Physician 2085R0202X NU
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

300 Ridge Medical Plaza Rd
Edgefield, SC 29824-4525

Mailing address

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

Other names 1

  • Edgefield County Healthcare, An Affiliate of Self Regional Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190104001084 SC Part A Provider - Critical Access Hospital 1557606118 Receives reassigned benefits from 58 practitioners
Practice locations: Edgefield, SC
O20190129003656 SC Part B Supplier - Clinic/Group Practice 1557606118 Receives reassigned benefits from 133 practitioners
4 other NPIs on this enrollment
Practice locations: Edgefield, SC; Johnston, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922582105. Details of each certification follow.

Hospital certification: CCN 421304

Legal name
SELF REGIONAL HEALTHCARE PARTNERS
Doing business as
EDGEFIELD COUNTY HEALTHCARE AN AFFILIATE OF SELF REGIONAL HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2004
Last certification
Sep 21, 2023
Beds
25
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jan 1, 2019 (1 total)
Organization structure
OtherNon-profit
Incorporated
Jun 14, 2018 in SC
Enrollment address
300 Ridge Medical Plaza Road
Edgefield, SC 29824-4525
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Edgefield County Healthcare an Affiliate of Self RCCN 421304 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0691083Edgefield County Healthcare300 Ridge Medical Plaza, Edgefield, SC 29824AccreditationJan 2, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Matthew T Logan Individual Corporate OfficerPresident Dec 21, 2021
Self Regional Healthcare Organization, Greenwood, SC Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
William F Gordon Individual W-2 Managing Employee Oct 1, 2024
Clint J Stewart Individual W-2 Managing Employee Oct 21, 2024

Owners & managing parties with NPI records 17

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 17

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 171

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 171

Affiliated clinicians 91

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 91

NPI Registry JSON

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1922582105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111",
            "fax_number": "864-725-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIDGE MEDICAL PLAZA RD",
            "city": "EDGEFIELD",
            "state": "SC",
            "postal_code": "298244525",
            "telephone_number": "803-637-3174",
            "fax_number": "803-637-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REGIONAL HEALTHCARE PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-24",
        "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": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgefield County Healthcare, An Affiliate of Self Regional Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgefield, SC

Sources for this page

Verify at the official NPI Registry.