NPIMap

Individual provider Active NPI

Jaclyn Matsuura

  • Emergency Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1386107761
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO3044 Issued in NV
Practice address
1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone
(702) 382-1958
NPI assigned
Apr 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X DO3044 NV Primary

Addresses

Primary practice location

1800 W Charleston Blvd
Las Vegas, NV 89102-2329

Mailing address

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

Other practice location 1

1301 N Rose Dr
Placentia, CA 92870-3802
Phone (714) 993-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220829000100 NV Practitioner - Emergency Medicine 7012391808 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

102 E Lake Mead Pkwy
Henderson, NV 89015-5575
Phone (702) 616-4600

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
19684CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians Emergency Medicine of Nevada Bessler PLLC Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Jul 1, 2024 Accepting new patients
Vituity-Nevada Medical Services Koury & Partners PC Emergency Medicine Current Accepting new patients
University Medical Center of Southern Nevada CurrentSince Jul 1, 2024 Accepting new patients
Vituity-Nevada Medical Services Koury & Partners PC Emergency Medicine CurrentSince Jul 9, 2024 Accepting new patients
Vituity-Nevada Medical Services Koury & Partners PC Emergency Medicine CurrentSince Jul 9, 2024 Accepting new patients
Glass Beach Medical Services a Medical Corporation Emergency Medicine Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

102 E Lake Mead Pkwy
Henderson, NV 89015
Phone (701) 564-2622

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

4980 W Sahara Ave
Ste 100
Las Vegas, NV 89146
Phone (702) 216-7365

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1386107761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022329",
            "telephone_number": "702-383-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022329",
            "telephone_number": "702-382-1958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 N Rose Dr",
            "address_purpose": "LOCATION",
            "city": "Placentia",
            "state": "CA",
            "postal_code": "928703802",
            "country_code": "US",
            "telephone_number": "714-993-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATSUURA",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "DO3044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.