NPIMap

Individual provider Active NPI

Amber Hicks-Thibodeau

  • Family Medicine Physician
  • Mooresville, NC
National Provider Identifier
1063869469
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2015-02105 Issued in NC
Practice address
798 Oak Ridge Farm Hwy. Suite a
Mooresville, NC 28115
Phone
(704) 658-0011
Fax
(704) 658-0012
NPI assigned
May 16, 2016
Last updated
Sep 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2015-02105 NC Primary

Addresses

Primary practice location

798 Oak Ridge Farm Hwy. Suite a
Mooresville, NC 28115

Mailing address

798 Oak Ridge Farm Hwy. Suite a
Mooresville, NC 28115
Phone (704) 658-0011

Other practice location 1

500 Gypsy Ln
Youngstown, OH 44504-1315
Phone (330) 884-3235

Other practice location 2

5170 Belmont Ave
Youngstown, OH 44505-1022
Phone (330) 759-2511

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amber.hicks.thibodeau.1@4693.direct.athenahealth.com

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
I20200615002723 NC Practitioner - Family Practice 1951691575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

7482 Waterside Crossing Blvd
Denver, NC 28037-3006
Phone (704) 827-0598

798 Oakridge Farm Hwy
Suite a
Mooresville, NC 28115-7924
Phone (704) 658-0011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.07 of 100Reported as apm
Quality
73.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015-02105NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. Single Specialty CurrentSince Apr 1, 2025 Accepting new patients
Duke Health Integrated Practice, Inc. Family Medicine CurrentSince Apr 1, 2025 Accepting new patients

Locations

294 N NC 16 Business Hwy
Ste A
Denver, NC 28037
Phone (704) 660-4041

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

131 Medical Park Rd
Ste 302
Mooresville, NC 28117
Phone (704) 660-4750

798 Oakridge Farm Hwy
Ste A
Mooresville, NC 28115
Phone (704) 658-0011

Interoperability endpoints

  • Direct secure messaging: ahicksthibodeau623214@direct.medicine.duke.edu
  • Direct secure messaging: amber.hicks.thibodeau.1@4693.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1063869469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "798 OAK RIDGE FARM HWY. SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28115",
            "telephone_number": "704-658-0011",
            "fax_number": "704-658-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "798 OAK RIDGE FARM HWY. SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28115",
            "telephone_number": "704-658-0011",
            "fax_number": "704-658-0012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Gypsy Ln",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445041315",
            "country_code": "US",
            "telephone_number": "330-884-3235",
            "fax_number": "330-884-3234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5170 Belmont Ave",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445051022",
            "country_code": "US",
            "telephone_number": "330-759-2511",
            "fax_number": "330-884-3234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKS-THIBODEAU",
        "first_name": "AMBER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-16",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2015-02105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amber.hicks.thibodeau.1@4693.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct access",
            "address_1": "798 Oak Ridge Farm Hwy. Suite A",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.