DR. DON TOSHIO MATSUURA MD
NPI 1720184120
Internal Medicine - Cardiovascular Disease in Hilo, HI

Quality Rating: 75 out of 100 score

NPI Status: Active since September 15, 2006

Contact Information

1248 KINOOLE ST
STE 104
HILO, HI
ZIP 96720
Phone: (808) 935-0056
Fax: (808) 969-7886

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Table of Contents

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Overall Quality Performance
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 43
Internal Medicine
Cardiovascular Disease
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About DON MATSUURA

This page provides the complete NPI Profile along with additional information for Don Matsuura, an internist established in Hilo, Hawaii with a medical specialization in Internal Medicine, focusing in cardiovascular disease and more than 43 years of experience. He graduated from University Of Hawaii John A. Burns School Of Medicine in 1983. The healthcare provider is registered in the NPI registry with number 1720184120 assigned on September 2006. The practitioner's primary taxonomy code is 207RC0000X with license number DEA AM2097435 (HI). The provider is registered as an individual and his NPI record was last updated 19 years ago.

NPI: 1720184120
Provider Name: DR. DON TOSHIO MATSUURA MD
Gender: Male
Entity Type: Individual
Location Address: 1248 KINOOLE ST STE 104 HILO, HI 96720
Location Phone: (808) 935-0056
Location Fax: (808) 969-7886
Mailing Address: 1061 KUAHIWI PLACE HILO, HI 96720
Mailing Phone: (808) 961-2061
Mailing Fax: (808) 969-7886
Medical School Name: UNIVERSITY OF HAWAII JOHN A. BURNS SCHOOL OF MEDICINE
Graduation Year: 1983
Is Sole Proprietor?: No
Enumeration Date: 09-15-2006
Last Update Date: 07-08-2007
Code Navigator

An internist like Don Matsuura is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Internal Medicine Cardiovascular Disease
Taxonomy Code: 207RC0000X
Type: Allopathic & Osteopathic Physicians
License No.: DEA AM2097435
License State: HI
Taxonomy Description: An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

HMSA

HMSA Bronze PPO I - PPO
HMSA Bronze PPO II HSA - PPO
HMSA Catastrophic Plan - PPO
HMSA Gold PPO I - PPO
HMSA Gold PPO II - PPO
HMSA Platinum PPO - PPO
HMSA Silver PPO - PPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
C98517	MEDICARE UPIN (02)
013839	MEDICARE ID-TYPE UNSPECIFIED (04)

Medicare Participation & PECOS Enrollment Status

Don Matsuura is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Don Matsuura is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 2769417138
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20051004001089
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

DME-Other DME (DE001N)
Continuous positive airway pressure (cpap) device (HCPCS:E0601)
1 DME suppliers used 18 Medicare Claims 18 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Electrocardiogram (ecg) up to 30 days continuous with review and report by health care professional
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Evaluation of single, dual, multiple lead or leadless pacemaker system or implantable defibrillator system, remote up to 90 days
Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days
Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days
Exercise or drug-induced heart stress test with electrocardiogram (ecg)
Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician
Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician
Heart muscle strain imaging
Heart rhythm review, and interpretation of continous external ekg over more than 48 hours up to 7 days
New patient office or other outpatient visit, 45-59 minutes
Programming of dual lead pacemaker system
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report
Telephone medical discussion with physician, 5-10 minutes
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $34.17 for a new patient copayment and $18.73 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 96720 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $136.68
Minimum New Patient Price $60.53
Maximum New Patient Price $180.05

Average New Patient Copayment $34.17
Minimum New Patient Copayment $15.13
Maximum New Patient Copayment $45.01

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $74.92
Minimum Established Patient Price $20.09
Maximum Established Patient Price $147.56

Average Established Patient Copayment $18.73
Minimum Established Patient Copayment $5.02
Maximum Established Patient Copayment $36.89

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 75, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

Final Score: 75 out of 100

The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.
Quality Score: N/A

The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
Promoting Interoperability Score: N/A

The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.
Improvement Activities Score: N/A

The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.
Cost Score: N/A

The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
Cost Score: N/A

The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Care transition documentation practice improvements	Yes	N/A
Implementation of practices/processes for care transition that include documentation of how a MIPS eligible clinician or group carried out a patient-centered action plan for first 30 days following a discharge (e.g., staff involved, phone calls conducted in support of transition, accompaniments, navigation actions, home visits, patient information access, etc.).
Electronic submission of Patient Centered Medical Home accreditation	Yes	N/A
I attest that I am a Patient Centered Medical Home (PCMH) or Comparable Specialty Practice that has achieved certification from a national program, regional or state program, private payer, or other body that administers patient-centered medical home accreditation and should receive full credit for the Improvement Activities performance category.
e-Prescribing	100%	2050
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange	100%	23
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Patient-Specific Education	100%	1979
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record	Yes	N/A
• Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.
Provide Patient Access	100%	1979
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	11%	1979
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Syndromic Surveillance Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit syndromic surveillance data. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_2_MULTI.
Use evidence-based decision aids to support shared decision-making.	Yes	N/A
Use evidence-based decision aids to support shared decision-making.
Use of certified EHR to capture patient reported outcomes	Yes	N/A
In support of improving patient access, performing additional activities that enable capture of patient reported outcomes (e.g., home blood pressure, blood glucose logs, food diaries, at-risk health factors such as tobacco or alcohol use, etc.) or patient activation measures through use of certified EHR technology, containing this data in a separate queue for clinician recognition and review.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Don Matsuura is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
HILO MEDICAL CENTER	1190 WAIANUENUE AVENUE HILO, HI 96720	(808) 932-3000	Acute Care Hospitals

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1720184120, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 4

Pos 4

Unchanged

Pos 5

Doubled → 2

Pos 6

Unchanged

Pos 7

Doubled → 8

Pos 8

Unchanged

Pos 9

Doubled → 4

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 2 → 4 1 → 2 4 → 8 2 → 4

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 7 + 4 + 0 + 2 + 8 + 8 + 1 + 4 + 24 = 60

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 60 is 60. The difference is the calculated check digit.

60 - 60 = 0

This NPI is valid

The calculated check digit is 0, which matches the last digit of 1720184120.

Other Providers at the Same Location

The following 6 providers are registered at the same or a nearby location.

DR. RODNEY TADASHI ONO M.D.

Internal Medicine

1248 KINOOLE ST, SUITE 101
HILO, HI 96720

Hawaii County (808) 935-8398

RODNEY T ONO MD INC

Clinic/Center

1248 KINOOLE ST, 101
HILO, HI 96720

Hawaii County (808) 935-8398

RODNEY T. ONO, M.D., INC

Internal Medicine (Cardiovascular Disease)

1248 KINOOLE ST, SUITE 101
HILO, HI 96720

Hawaii County (808) 935-8398

JOYFUL LIVING, LLC

Family Medicine

1248 KINOOLE ST, SUITE 101
HILO, HI 96720

Hawaii County (808) 935-8398

DR. BENJAMIN M ONO MD

Internal Medicine

1248 KINOOLE ST, STE 103
HILO, HI 96720

Hawaii County (808) 935-7137

DR. MATTHEW S. DYKEMA D.O.

Family Medicine

1248 KINOOLE ST, SUITE 101
HILO, HI 96720

Hawaii County (808) 935-8398

About DON MATSUURA

Location Map

Specialty - Primary Taxonomy

Internal Medicine Cardiovascular Disease

Insurance Plans Accepted

Additional Identifiers

Medicare Participation & PECOS Enrollment Status

Is the provider registered in PECOS? Yes

PECOS PAC ID: 2769417138

PECOS Enrollment ID: I20051004001089

Accepts Medicare Assignment? Yes

Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

Eligible to Order or Refer a Home Health Agency (HHA): Yes

Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

Durable Medical Equipment

Areas of Expertise

Electrocardiogram (ecg) up to 30 days continuous with review and report by health care professional

Established patient office or other outpatient visit, 20-29 minutes

Established patient office or other outpatient visit, 30-39 minutes

Established patient office or other outpatient visit, 40-54 minutes

Evaluation of single, dual, multiple lead or leadless pacemaker system or implantable defibrillator system, remote up to 90 days

Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days

Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days

Exercise or drug-induced heart stress test with electrocardiogram (ecg)

Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician

Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician

Heart muscle strain imaging

Heart rhythm review, and interpretation of continous external ekg over more than 48 hours up to 7 days

New patient office or other outpatient visit, 45-59 minutes

Programming of dual lead pacemaker system

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report

Telephone medical discussion with physician, 5-10 minutes

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

Physician Visit Costs

New Patients Visit Costs *

Established Patients Visit Costs *

Overall MIPS Quality Performance

Final Score: 75 out of 100

Quality Score: N/A

Promoting Interoperability Score: N/A

Improvement Activities Score: N/A

Cost Score: N/A

Cost Score: N/A

Quality Reporting

Find Provider Hospital Affiliations - Privileges

Reviews for DR. DON TOSHIO MATSUURA MD

NPI NPI Number Validation

How NPI Validation Works

Digit-by-digit view

Step 1: Double every other digit from the right

Step 2: Add all digits plus the NPI constant

Step 3: Find the amount needed to reach the next multiple of 10

Other Providers at the Same Location

Frequently Asked Questions