NPIMap

Organization Active NPI

Spine Care Center, LLC

  • Interventional Pain Medicine Physician
  • Cottonwood Heights, UT
National Provider Identifier
1992736557
Registry record updated Aug 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
SPINE CARE CENTER, LLC
Practice address
6750 S Highland Drive
Suite 100
Cottonwood Heights, UT 84121
Phone
(801) 685-7246
Fax
(801) 747-5487
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2016

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

Authorized official

Name
Dr. Kyle S Matsumura, MDNPI 1619907490
Title
Managing Member
Phone
(801) 685-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

6750 S Highland Drive
Suite 100
Cottonwood Heights, UT 84121

Mailing address

6750 S Highland Drive
Suite 100
Cottonwood Heights, UT 84121
Phone (801) 685-7246

Other names 1

  • UTAH PAIN SPECIALISTS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061114000306 UT Part B Supplier - Clinic/Group Practice 4789682352 Receives reassigned benefits from 8 practitioners
Practice locations: Cottonwood Heights, UT

National Provider Directory

National Provider Directory

Locations

6750 S Highland Dr
Cottonwood Heights, UT 84121
Phone (801) 685-7246

6750 S Highland Dr
#100
Cottonwood Heights, UT 84121

6750 S Highland Dr
Ste 100
Salt Lake Cty, UT 84121
Phone (801) 685-7246

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1992736557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 S HIGHLAND DRIVE",
            "address_2": "SUITE 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": "SUITE 100",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-685-7246",
            "fax_number": "801-747-5487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2016-08-15",
        "status": "A",
        "authorized_official_last_name": "MATSUMURA",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "801-685-7246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UTAH PAIN SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cottonwood Heights, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.