Active NPI
Nichole R Thibodeaux, PA-C
- Medical Physician Assistant
- Houston, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA13619
- Practice address
- 1900 North Loop W Ste 580
Houston, TX 77018-8163 - Phone
- (713) 714-5376
- NPI assigned
- Nov 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA.0003820 | CO | |
| Medical Physician Assistant | 363AM0700X | PA13619 | TX | Primary |
Addresses
Primary practice location
1900 North Loop W Ste 580
Houston, TX 77018-8163
Mailing address
1900 North Loop W Ste 580
Houston, TX 77018-8163
Phone (713) 714-5376
Other practice location 1
8565 Poplar Way
Highlands Ranch, CO 80130-3602
Phone (720) 348-2800
Other practice location 2
11960 Lioness Way Ste 210
Parker, CO 80134-5644
Phone (303) 695-6106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1900 N Loop W
Suite 580
Houston, TX 77018-8163
Phone (713) 714-5376
7900 Fannin St
Suite 4000
Houston, TX 77054-2935
Phone (713) 512-7500
Hospital & facility affiliations
- Memorial Hermann Hospital System
- Memorial Hermann Memorial City Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Gulf Coast PLLC | Current | Accepting new patients | |
| Privia Medical Group Gulf Coast, PLLC | Current | Accepting new patients |
Locations
646 FM 517 Rd W
Dickinson, TX 77539
Phone (281) 309-9001
7900 Fannin St
Ste 4000
Houston, TX 77054
Phone (713) 512-7027
1900 North Loop W
Ste 580
Houston, TX 77018
Phone (713) 714-5376
10970 Shadow Creek Pkwy
Ste 100
Pearland, TX 77584
Phone (281) 398-8500
17510 W Grand Pkwy S
Ste 430
Sugar Land, TX 77479
Phone (713) 578-3820
Interoperability endpoints
- nichole.thibodeaux.1@8042.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 and National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Houston, TX
- NPI 1578969465
-
- Interventional Pain Medicine Physician
- San Antonio, TX
- NPI 1457167033
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Houston, TX
- NPI 1730132234
-
- General Acute Care Hospital
- Houston, TX
- NPI 1740233782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599609600000",
"number": "1083010052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 NORTH LOOP W STE 580",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770188163",
"telephone_number": "713-714-5376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 NORTH LOOP W STE 580",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770188163",
"telephone_number": "713-714-5376"
}
],
"practiceLocations": [
{
"address_1": "8565 Poplar Way",
"address_purpose": "LOCATION",
"city": "Highlands Ranch",
"state": "CO",
"postal_code": "801303602",
"country_code": "US",
"telephone_number": "720-348-2800",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11960 Lioness Way Ste 210",
"address_purpose": "LOCATION",
"city": "Parker",
"state": "CO",
"postal_code": "801345644",
"country_code": "US",
"telephone_number": "303-695-6106",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THIBODEAUX",
"first_name": "NICHOLE",
"middle_name": "R",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-18",
"last_updated": "2020-09-09",
"certification_date": "2020-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "PA.0003820",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA13619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.