Cleveland Children'S Clinic, PLLC
Organization Active NPI Pediatrics Physician · Cleveland, MS
NPI 1093178337 · NPPES record last updated Jul 20, 2023
Key facts
- NPI
- 1093178337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- CLEVELAND CHILDREN'S CLINIC, PLLC
- Practice address
- 818 E Sunflower Rd
Cleveland, MS 38732-2824 - Phone
- (662) 579-3449
- Fax
- (662) 579-3459
- NPI assigned
- Apr 4, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Jose Brevil, ED.D.
- Title
- Executive Director
- Phone
- (662) 579-3449
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 4
-
Nohemie Brevil, M.D., FAAP
-
Xiaoming Hester, FNP-C
-
Sylvia Cope Duncan, LPC
-
Allysa McNeer, CPNP-PC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2111970 | Cleveland Children'S Clinic, PLLC | Certificate of waiver | Apr 18, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230808003116 | MS | Part B Supplier - Clinic/Group Practice | 0749642783 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment Practice locations: Greenville, MS; Cleveland, MS |
National Provider Directory
- Tax ID family
- Cleveland Children'S Clinic
Locations
1431 S Colorado St
Greenville, MS 38703
Phone (662) 579-3449
Interoperability endpoints
- https://api.platform.athenahealth.com/13708/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | 23162 | MS | |
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
818 E Sunflower Rd
Cleveland, MS 38732-2824
Mailing address
PO Box 60
Cleveland, MS 38732-0060
Phone (662) 579-3449
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00325056 | Medicaid | MS |
Other providers in Cleveland, MS
- Children'S Dental Clinic
- Cole Clark
- Michael Stuart Clark I
- Steven Glenn Clark
- Cleveland Cardiology PLLC
- Cleveland Dental Clinic
- Cleveland Eye Clinic PA
- Cleveland Foot Clinic Inc
- Cleveland Medical Arts Pharmacy Inc
- Cleveland Medical Arts Pharmacy Inc
All providers in Cleveland, MS · Pediatrics Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.