NPIMap

Individual provider Active NPI

Kevin David Hickey, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1861827792
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-07109 Issued in NC
Practice address
1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204-2963
Phone
(704) 446-2060
NPI assigned
Sep 11, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-07109 NC Primary

Addresses

Primary practice location

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204-2963

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 446-1340

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address khickey136984@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170726002746 SC Practitioner - Physician Assistant 9739486721 Reassigns benefits to 1 organization
I20171102003474 NC Practitioner - Physician Assistant 9739486721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

1025 Morehead Medical Dr
Suite 275a
Charlotte, NC 28204-2963
Phone (704) 355-0607

Hospital & facility affiliations

  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Carolinas Rehabilitation Inpatient rehabilitation facility, Charlotte, NC, CCN 343026

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2705SCMDDentist
0010-07109NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Mar 6, 2017 Accepting new patients
Carolinas Medical Center CurrentSince Dec 18, 2019 Accepting new patients
Carolinas Medical Center CurrentSince Dec 18, 2019 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Aug 14, 2017 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 6, 2017 Accepting new patients
Carolinas Medical Center Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204
Phone (704) 355-1813

704 Gold Hill Rd
Ste 203
Fort Mill, SC 29715
Phone (803) 835-0405

134 Professional Park Dr
Rock Hill, SC 29732
Phone (803) 329-3130

Interoperability endpoints

  • Direct secure messaging: khickey136984@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 7

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": "1378857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1861827792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MOREHEAD MEDICAL DR",
            "address_2": "STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042963",
            "telephone_number": "704-446-2060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072134",
            "country_code": "US",
            "telephone_number": "704-446-1340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKEY",
        "first_name": "KEVIN",
        "middle_name": "DAVID",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-11",
        "last_updated": "2024-07-15",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khickey136984@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1025 Morehead Medical Dr",
            "address_2": "Ste 300",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.