NPIMap

Organization Active NPI

Children's International, LLC

  • Rural Health Clinic/Center
  • Biloxi, MS
National Provider Identifier
1164030979
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHILDREN'S INTERNATIONAL, LLC
Practice address
2561 Pass Rd
Biloxi, MS 39531-2125
Phone
(228) 400-0098
Fax
(833) 915-0148
NPI assigned
Jul 17, 2020
Last updated
Jul 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Authorized official

Name
Dr. Eduardo Hernandez, MD
Title
Ceo
Phone
(985) 646-1580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2561 Pass Rd
Biloxi, MS 39531-2125

Mailing address

59101 Amber St
Slidell, LA 70461-3708
Phone (985) 646-1580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200908001699 MS Part A Provider - Rural Health Clinic 1254633308 Practice locations: Biloxi, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164030979. Details of each certification follow.

Rural health clinic certification: CCN A53802

Legal name
CHILDREN'S INTERNATIONAL, LLC
Doing business as
CHILDREN'S INTERNATIONAL MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 24, 2020
Last certification
Nov 24, 2020
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 13, 1993 in LA
Enrollment address
2561 Pass Rd
Biloxi, MS 39531-2125

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0319688Children's International, LLC2561 Pass Rd, Biloxi, MS 39531Certificate of waiverAug 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Children's International LLC27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Eduardo J Hernandez Individual 5% Or Greater Direct Ownership Interest Jan 20, 2010 50%
Corporate Officer Jan 20, 2010 50%
Corporate Director Jan 20, 2010 50%
Brittany Frost Individual W-2 Managing EmployeeChief Business Officer Jul 13, 2020
The Living Trust of Eduardo and Heidi Hernandez Organization, Slidell, LA 5% Or Greater Direct Ownership Interest Sep 5, 2013 100%
Heidi B Hernandez Individual 5% Or Greater Indirect Ownership Interest Jan 20, 2010 50%

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Children's International Medical GroupFranklinton, LA, CCN 193918 Rural health clinic Operational/Managerial Control (100%) Nov 27, 2013
Children's International Medical GroupAmite, LA, CCN 193919 Rural health clinic Operational/Managerial Control (100%) Nov 27, 2013
Children's International Medical GroupPicayune, MS, CCN 253928 Rural health clinic Operational/Managerial Control (100%) Nov 27, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1164030979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59101 AMBER ST",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704613708",
            "telephone_number": "985-646-1580",
            "fax_number": "888-863-4274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2561 PASS RD",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395312125",
            "telephone_number": "228-400-0098",
            "fax_number": "833-915-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S INTERNATIONAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "985-646-1580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

Verify at the official NPI Registry.