Kyle Shigeru Matsumura, MD

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

951306801205 Issued in UT

Practice address

6750 S Highland Drive
Ste 100
Cottonwood Heights, UT 84121

Phone

(801) 685-7246

Fax

(801) 747-5487

NPI assigned

Jul 4, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

25.31 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

84.36

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Spine Care Center, LLC

  dba Utah Pain Specialists

  • Interventional Pain Medicine Physician
  • Cottonwood Heights, UT
  • NPI 1992736557
  Medicare reassignment NPD Authorized official
• Millcreek Anesthesia PC

  • Anesthesiology Physician
  • Salt Lake City, UT
  • NPI 1306879820
  NPD (past)

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1619907490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 S HIGHLAND DRIVE",
            "address_2": "STE 100",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-685-7246",
            "fax_number": "801-747-5487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 S HIGHLAND DRIVE",
            "address_2": "STE 100",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-685-7246",
            "fax_number": "801-747-5487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUMURA",
        "first_name": "KYLE",
        "middle_name": "SHIGERU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "UT",
            "license": "951306801205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D5367",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAL MEDICAL LICENSE #",
            "identifier": "G79891",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH MEDICAL LICENSE #",
            "identifier": "951306801205",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guadalupe Martinez-Garcia
• Aspen Martinez
• Emily Alicia Martinez
• Mat Ventures LLC
• Kahopewai Mateaki
• Mary E Mattingly
• Garan Maughan
• Maybird Medical, PLLC
• Michael Anthony McAlister, APRN
• Ashlyn Kiyoko McBride

• Interventional Pain Medicine Physician in Cottonwood Heights, UT
• Providers in Cottonwood Heights, UT by specialty
• Interventional Pain Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.