1. Home
  2. Directory
  3. Utah
  4. Cottonwood Heights
  5. Pain Medicine
  6. NPI Profile

DR. KYLE SHIGERU MATSUMURA MD
NPI 1619907490
Pain Medicine - Interventional Pain Medicine in Cottonwood Heights, UT

Active since July 04, 2006PECOS Enrolled
0/100
CMS Quality Rating
6750 S HIGHLAND DRIVE, STE 100, COTTONWOOD HEIGHTS, UT 84121(801) 685-7246(801) 747-5487 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 7, 2023, Aug 12, 2016 (2 updates tracked since 2016).

About Dr. Kyle Shigeru Matsumura Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KYLE SHIGERU MATSUMURA MD (NPI 1619907490) is an individual interventional pain medicine provider in Cottonwood Heights, Utah, licensed in Utah (951306801205) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619907490
Entity TypeIndividualMale
Primary Taxonomy208VP0014X
Provider Legal NameDR. KYLE SHIGERU MATSUMURACredential: MD
Location Address6750 S HIGHLAND DRIVE, STE 100Cottonwood Heights, UT 84121
Mailing Address6750 S Highland Drive, Ste 100Cottonwood Heights, UT 84121 · (801) 685-7246 · Fax (801) 747-5487
Phone(801) 685-7246
Fax(801) 747-5487
Sole ProprietorNo
Enumeration DateJuly 4, 2006
Last NPPES UpdateMarch 7, 20232 updates tracked since enumeration
✔ NPI 1619907490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPain Medicine · Interventional Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code208VP0014X
License✔ Licensed in UT · 951306801205
Definition
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.
6750 S HIGHLAND DRIVE, Cottonwood Heights, UT 84121
Open in Google Maps ↗

Other Identifiers 3

MedicaidD5367UT
OtherG79891UT · Cal Medical License #
Other951306801205UT · Utah Medical License #

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kyle Shigeru Matsumura Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kyle Matsumura reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Spine Care Center, LLC
Same address
Interventional Pain Medicine
6750 S HIGHLAND DRIVE, SUITE 100
Cottonwood Heights, UT 84121
  • Reassigned Medicare billing, Utah enrollment
  • 5 clinicians in this Medicare group
NPI 1992736557 (801) 685-7246

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
34 services33 patients
Injection of substance into lower spine canal using imaging guidance 62323
This procedure involves injecting a substance into your lower spine canal, guided by real-time images. It's done to diagnose or treat various conditions. You may feel slight discomfort, but it's generally safe and can provide valuable information for your treatment plan.
13 services13 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84121 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

0/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality0
Improvement Activities0

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEIDI MARIE DUCKWORTH MSN, APRN, FNP-C
Nurse Practitioner (Family)
6750 S HIGHLAND DRIVE, SUITE 100
COTTONWOOD HEIGHTS, UT 84121
Salt Lake County (801) 685-7246
RAJIV SHAH M.D
Pain Medicine (Interventional Pain Medicine)
6750 S HIGHLAND DRIVE
COTTONWOOD HEIGHTS, UT 84121
Salt Lake County (801) 685-7246
DR. ARUN RAJAGOPAL M.D.
Pain Medicine (Interventional Pain Medicine)
6750 S HIGHLAND DRIVE, SUITE 100
COTTONWOOD HEIGHTS, UT 84121
Salt Lake County (801) 685-7246
SPINE CARE CENTER, LLC
Pain Medicine (Interventional Pain Medicine)
6750 S HIGHLAND DRIVE, SUITE 100
COTTONWOOD HEIGHTS, UT 84121
Salt Lake County (801) 685-7246

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kyle Matsumura's NPI number?

The NPI number for Kyle Matsumura is 1619907490. It was assigned to this individual provider in the NPPES registry on July 4, 2006.

Where is Kyle Matsumura located?

Kyle Matsumura practices at 6750 S Highland Drive Ste 100, Cottonwood Heights, UT 84121. The listed phone number is (801) 685-7246.

What is Kyle Matsumura's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Is Kyle Matsumura enrolled in Medicare?

Yes. Kyle Matsumura is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kyle Matsumura's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kyle Matsumura reassigns Medicare benefits to Spine Care Center, LLC (Cottonwood Heights, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kyle Matsumura's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kyle Matsumura was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.