NPIMap

Individual provider Active NPI

Duke Tsukasa Matsuyama, D.O.

  • Anesthesiology Physician
  • Fayetteville, NC
National Provider Identifier
1689712077
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
200401415 Issued in NC
Practice address
957 Old McPherson Church Rd
Fayetteville, NC 28303-5382
Phone
(910) 323-9933
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 200401415 NC Primary

Addresses

Primary practice location

957 Old McPherson Church Rd
Fayetteville, NC 28303-5382

Mailing address

152 Westwick LN
Apt. 2
Fayetteville, NC 28314-2737
Phone (937) 684-1007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100830000431 NC Practitioner - AnesthesiologyPractitioner - Interventional Pain Management 3274657168 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Interventional Pain Management
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

150 Robeson St
Fayetteville, NC 28301-5570
Phone (910) 615-1000

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-4000

210 Medical Pavilion Dr
Raeford, NC 28376-9111
Phone (910) 904-8000

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 343-7000

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 784-3034

800 Tilghman Dr
Dunn, NC 28334-5510
Phone (910) 892-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200401415NCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology Current Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Mar 2, 2022 Accepting new patients

Locations

501 S Poplar St
Elizabethtown, NC 28337
Phone (910) 862-4043

150 Robeson St
Fayetteville, NC 28301
Phone (910) 609-1000

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

210 Medical Pavilion Dr
Raeford, NC 28376
Phone (910) 904-8000

2520 Independence Blvd
Ste 200
Wilmington, NC 28412
Phone (910) 442-1100

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 3

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1689712077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 WESTWICK LN",
            "address_2": "APT. 2",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142737",
            "telephone_number": "937-684-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "957 OLD MCPHERSON CHURCH RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035382",
            "telephone_number": "910-323-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUYAMA",
        "first_name": "DUKE",
        "middle_name": "TSUKASA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "200401415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.