DR. KYLE SHIGERU MATSUMURA (NPI# 1619907490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1619907490 |
Entity Type | Individual |
Full Name | DR. KYLE SHIGERU MATSUMURA |
Credential | MD |
Practice Address |
6750 S Highland Drive Ste 100 Cottonwood Heights UT 84121 |
Practice Telephone | 8016857246 |
Practice Fax Number | 8017475487 |
Mailing Telephone | 8016857246 |
Mailing Fax Number | 8017475487 |
Enumeration Date | 2006-07-04 |
Last Update Date | 2016-08-12 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
951306801205 | UT | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
UT | D5367 | 05 | |
UT | CAL MEDICAL LICENSE # | G79891 | 01 |
UT | DEA NUMBER | BM5218652 | 01 |
UT | UTAH MEDICAL LICENSE # | 951306801205 | 01 |
Street Address |
6750 S HIGHLAND DRIVE STE 100 |
City | COTTONWOOD HEIGHTS |
State | UT |
Zip Code | 84121 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043521016 | Heidi Marie Duckworth | Nurse Practitioner | 6750 S Highland Drive, Suite 100, Cottonwood Heights, UT 84121 | 2010-06-24 |
1750426276 | Anna Louise Peters | Physician Assistant | 6750 S Highland Drive, Ste 100, Cottonwood Heights, UT 84121 | 2007-02-21 |
1992736557 | Spine Care Center, LLC | Pain Medicine | 6750 S Highland Drive, Suite 100, Cottonwood Heights, UT 84121 | 2006-07-05 |
1942230602 | Arun Rajagopal | Pain Medicine | 6750 S Highland Drive, Suite 100, Cottonwood Heights, UT 84121 | 2006-07-05 |
1700817442 | Kathy Jean Hemming | Physician Assistant | 6750 S Highland Drive, Suite 100, Cottonwood Heights, UT 84121 | 2006-07-05 |
1285664185 | Rajiv Shah | Anesthesiology | 6750 S Highland Drive, Cottonwood Heights, UT 84121-1829 | 2006-07-04 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407483522 | Kaitlyn Horne | Behavior Technician | 6910 S. Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-26 |
1952936387 | Jared Wells | Behavior Technician | 6910 S Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-05 |
1518591874 | Slc Plastic Surgery LLC | Plastic Surgery | 6686 Highland Drive, Cottonwood Heights, UT 84121 | 2020-02-26 |
1093273708 | Anna O'hearon | Counselor | New Roads Behavioral Health, 2450 Fort Union Blvd, Cottonwood Heights, UT 84121 | 2019-03-12 |
1053883181 | Charles Keller IIi | Pediatrics | 2198 S Yvonne Rd #344, Salt Lake City, UT 84121 | 2018-12-31 |
1669964516 | Marissa King | Specialist | 1141 E. 3900 S. Suite 150a, Salt Lake, UT 84121 | 2018-06-05 |
1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
1700315462 | Nelson & Tillmann Family Dentistry, PC | Dentist | 5872 S. 900 E. Ste 202, Salt Lake City, UT 84121 | 2017-06-07 |
1912430588 | Wasatch Midwifery and Wellness, LLC | Dietitian, Registered | 6440 S Wasatch Blvd, Ste 140, Holladay, UT 84121 | 2017-04-10 |
1407308331 | Tina Polgar | Registered Nurse | 6244 Highland Drive, Murray, UT 84121 | 2016-10-26 |
Find all providers in zip 84121 |
Taxonomy Code | 208VP0014X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pain Medicine |
Specialization | Interventional Pain Medicine |
Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992736557 | Spine Care Center, LLC | Pain Medicine | 6750 S Highland Drive, Suite 100, Cottonwood Heights, UT 84121 | 2006-07-05 |
1942230602 | Arun Rajagopal | Pain Medicine | 6750 S Highland Drive, Suite 100, Cottonwood Heights, UT 84121 | 2006-07-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972862605 | Intermountain Pain Management and Injury, Inc | Pain Medicine | 6575 S Redwood Rd, St 201, Taylorsville, UT 84123-5688 | 2012-05-15 |
1285958439 | Advanced Spine Pain Specialists | Pain Medicine | 286 N Gateway Dr Ste 201, Providence, UT 84332-5603 | 2010-03-17 |
1326665829 | Wasatch Wellness Center LLC | Pain Medicine | 1215 S 1680 W, Orem, UT 84058-4939 | 2020-06-30 |
1689226391 | Utah Intermountain Pain Management | Pain Medicine | 8822 S Redwood Rd Ste 113, West Jordan, UT 84088-9341 | 2019-07-12 |
1568909836 | Glacier Peak Pain Care Pllc | Pain Medicine | 1407 N 2000 W, Clinton, UT 84015-8562 | 2017-01-25 |
1073959714 | Wasatch Sports, Spine & Pain Treatment Center Pllc | Pain Medicine | 680 E Main St, 202, Lehi, UT 84043-2241 | 2013-05-21 |
1841531340 | Wasatch Pain Solutions, PC | Pain Medicine | 661 W 10600 S, South Jordan, UT 84095-8524 | 2013-03-07 |
1376821587 | Canyon Ridge Pain and Spine PC | Pain Medicine | 1551 Renaissance Towne Dr, Suite 460, Bountiful, UT 84010-7667 | 2011-07-22 |
1063721850 | Alta Pain Physicians, Pllc | Pain Medicine | 11333 S 1000 E, #102, Sandy, UT 84094-5428 | 2010-09-28 |
1861643330 | Craig William Davis | Pain Medicine | 3181 W 9000 So, West Jordan, UT 84088 | 2008-10-02 |
Find all providers with the same taxonomy |
City | COTTONWOOD HEIGHTS |
Zip Code | 84121 |
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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.