SELF MEDICAL GROUP (NPI# 1720475221) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720475221 |
| Entity Type | Organization |
| Organization Name | SELF MEDICAL GROUP |
| Other Organization Name | PEDIATRIC ASSOCIATES GREENWOOD, A DIVISION OF SELF MEDICAL GROUP |
| Practice Address |
102 Katie Ct Greenwood SC 29646-4068 |
| Practice Telephone | 8649434279 |
| Mailing Telephone | 8649434279 |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-04-24 |
| Authorized Official Name | JAMES PFEIFFER (MANAGED CARE) |
| Authorized Official Telephone | 8647254253 |
| Is Organization Subpart | Y |
| Parent Organization Name | SELF MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric Associates Greenwood, A Division of Self Medical Group | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487212130 | Self Medical Group | Family Medicine | 105 Vinecrest Ct # 510, Greenwood, SC 29646-8031 | 2019-05-29 |
| 1750800264 | Self Medical Group | Family Medicine | 110 Highway 246 N, Greenwood, SC 29649-8748 | 2017-09-15 |
| 1760808083 | Self Medical Group | Clinic/Center | 450 Old Brickyard Rd, Greenwood, SC 29649-8681 | 2014-03-11 |
| 1588969448 | Self Medical Group | Nurse Practitioner | 104 Liner Drive, Greenwood, SC 29646 | 2011-01-24 |
| 1417252636 | Self Medical Group | Family Medicine | 138 Wells Avenue, Greenwood, SC 29646-3837 | 2011-01-19 |
| 1376843037 | Self Medical Group | Obstetrics & Gynecology | 107 Venture Court, Greenwood, SC 29649-8558 | 2010-10-28 |
| 1629382056 | Self Medical Group | Family Medicine | 207 Holiday Road, Mccormick, SC 29835-3430 | 2010-07-27 |
| 1942528161 | Self Medical Group | Family Medicine | 167 Greenwood Ave S, Ware Shoals, SC 29692 | 2010-05-12 |
| 1134442890 | Self Medical Group | Physician Assistant | 115 Academy Avenue, Unit A, Greenwood, SC 29646 | 2010-03-10 |
| 1457685570 | Self Medical Group | Surgery | 160 Academy Avenue, Greenwood, SC 29646-3808 | 2009-09-22 |
| Street Address |
102 KATIE CT |
| City | GREENWOOD |
| State | SC |
| Zip Code | 29646-4068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518929835 | Carolina Health Centers, Inc. | Clinic/Center | 102 Katie Ct, Greenwood, SC 29646-4068 | 2006-04-03 |
| 1689060832 | Anthony Johnson | Pediatrics | 102 Katie Ct, Greenwood, SC 29646-4068 | 2015-04-14 |
| 1841502440 | Gail L Monson | Nurse Practitioner | 102 Katie Ct, Greenwood, SC 29646-4068 | 2010-07-12 |
| 1639231517 | Roy P Baker | Obstetrics & Gynecology | 102 Katie Ct, Greenwood, SC 29646-4068 | 2006-12-15 |
| 1477641975 | Jimmell Racquel Felder | Pediatrics | 102 Katie Ct, Greenwood, SC 29646-4068 | 2006-10-10 |
| 1508818360 | Cecily S Hughes | Pediatrics | 102 Katie Ct, Greenwood, SC 29646-4068 | 2006-05-17 |
| 1760431886 | Heather S Gallman | Pediatrics | 102 Katie Ct, Greenwood, SC 29646-4068 | 2006-05-08 |
| 1336107879 | Linda L Fuqua | Pediatrics | 102 Katie Ct, Greenwood, SC 29646-4068 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114535416 | Supriya Lal | Dietitian, Registered | 303 Parkwood Rd, Greenwood, SC 29646 | 2020-07-22 |
| 1174158406 | Mara L Schwartz | Registered Nurse | 1226 Spring St., Diabtes Education Department, Greenwood, SC 29646 | 2020-03-06 |
| 1487213724 | Greater Greenwood United Ministry | Family Medicine | 1404 Edgefield Street, Greenwood, SC 29646 | 2019-06-11 |
| 1346747995 | Kelli Diane Clune | Nurse Practitioner | 115 E Alexander Ave, Greenwood, SC 29646 | 2018-04-10 |
| 1184150112 | Sanquinette Sanders Brownlee | Nurse Practitioner | 929 Phoenix Stret, Clinica Gratis, Greenwood, SC 29646 | 2017-05-11 |
| 1194258426 | Kimberley Lovejoy | Assistant Behavior Analyst | 210a Birchtree, Greenwood, SC 29646 | 2017-04-04 |
| 1427590900 | Rejuvenation Massage By Frances | Clinic/Center | 610 Chace Avenue, Greenwood, SC 29646 | 2016-11-15 |
| 1932651643 | Hayley Smith | Counselor | 110 Court Ave W, Greenwood, SC 29646 | 2016-10-28 |
| 1942757927 | Towanda Morton | Community Health Worker | 303 Suite B South Main Street, Greenwood, SC 29646 | 2016-09-07 |
| 1770039976 | Bragan Mace | Pharmacist | 1376 South Main St., Greenwood, SC 29646 | 2016-08-28 |
| Find all providers in zip 29646 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841715539 | Happicare One LLC Ppec Pediatric Daycare | Pediatrics | 213 W Park Ave, Greenwood, MS 38930-3008 | 2017-08-03 |
| 1497072532 | Ryan Timothy Grimm | Pediatrics | 333 E County Line Road, Suite B, Greenwood, IN 46143-1080 | 2010-04-29 |
| 1043420078 | Jennifer Lynn Havener | Pediatrics | 333 E County Line Rd Ste B, Greenwood, IN 46143 | 2007-05-22 |
| 1952357667 | Brenda P Viegas | Pediatrics | 360 S Madison Ave, # 210, Greenwood, IN 46142-3150 | 2006-05-25 |
| 1790754000 | Billy Boldon | Pediatrics | 1405 Strong Ave, Greenwood, MS 38930-4035 | 2006-03-17 |
| 1649245101 | Marjorie E Lake | Pediatrics | 3209 W Smith Valley Rd, Ste. 251, Greenwood, IN 46142-8495 | 2006-02-20 |
| 1386620961 | Jeremy Wade Roscoe | Pediatrics | 401 Camby Ct, Greenwood, IN 46142-4085 | 2005-12-15 |
| 1649252610 | Erica R Fledderjohn | Pediatrics | 900 Averitt Rd, Greenwood, IN 46143-9540 | 2005-11-16 |
| 1215919295 | Christina C Fox | Pediatrics | 1703 W Stones Crossing Rd Ste 330, Greenwood, IN 46143-8558 | 2005-11-16 |
| 1962403436 | Clark Kramer | Pediatrics | 1040 Sierra Drive, Suite 400, Greenwood, IN 46143-7241 | 2005-08-09 |
| Find all providers in GREENWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.