NPIMap

Children'S International, LLC

Organization Active NPI Rural Health Clinic/Center · Biloxi, MS

NPI 1164030979 · NPPES record last updated Jul 17, 2020

Key facts

NPI
1164030979
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 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
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 26

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

View all 26

Facilities with the same owner 7

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0319688Children'S International, LLC
2561 Pass Rd, Biloxi, MS 39531		Certificate of waiverAug 5, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

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
LLC · Proprietary
Incorporated
Apr 13, 1993 in LA
Enrollment address
2561 Pass Rd
Biloxi, MS 39531-2125

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 Employee
Chief 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 Group
Franklinton, LA · CCN 193918		 Rural health clinic Operational/Managerial Control (100%) Nov 27, 2013
Children'S International Medical Group
Amite, LA · CCN 193919		 Rural health clinic Operational/Managerial Control (100%) Nov 27, 2013
Children'S International Medical Group
Picayune, MS · CCN 253928		 Rural health clinic Operational/Managerial Control (100%) Nov 27, 2013

Medicare enrollment records

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

National Provider Directory

Tax ID family
Children'S International LLC (27 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

2561 Pass Rd
Biloxi, MS 39531-2125

Mailing address

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

Other providers in Biloxi, MS

All providers in Biloxi, MS · Rural Health Clinic/Center in Mississippi

Sources for this page

Verify at the official NPI Registry.