NPIMap

Organization Active NPI

Children's International, LLC

Doing business as Children's International Medical Group

  • Rural Health Clinic/Center
  • Poplarville, MS
National Provider Identifier
1629778147
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHILDREN'S INTERNATIONAL, LLC
Doing business as
Children's International Medical Group
Practice address
345 Buck Kirkland Rd.
Poplarville, MS 39470
Phone
(985) 646-1580
Fax
(888) 863-4274
NPI assigned
Mar 3, 2023
Last updated
Mar 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Authorized official

Name
Lindsey Zierhut
Title
Director of Medical Staff Affairs
Phone
(985) 646-1580

Specialties & licenses 1

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

Addresses

Primary practice location

345 Buck Kirkland Rd.
Poplarville, MS 39470

Mailing address

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

Other names 1

  • Children's International Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230508002676 MS Part A Provider - Rural Health Clinic 1254633308 Practice locations: Poplarville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629778147. Details of each certification follow.

Rural health clinic certification: CCN A53837

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 1, 2023
Last certification
Nov 1, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 13, 1993 in LA
Enrollment address
345 Buck Kirkland Rd
Poplarville, MS 39470-3215

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
25D2277739Children's International Medical Group345 Buck Kirkland Rd, Poplarville, MS 39470Certificate of waiverMar 2, 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

Locations

345 Buck Kirkland Rd
Poplarville, MS 39470
Phone (601) 746-4648

Ownership & related parties

All disclosed owners & managing parties 5

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 Corporate OfficerManager of Living Trust Jan 20, 2010 50%
Corporate DirectorManager of Living Trust Jan 20, 2010 50%
Lacey Shaw Individual W-2 Managing EmployeeChief Operating Officer Jul 6, 2010
Brittany Frost Individual W-2 Managing EmployeeChief Business Officer Aug 1, 2009
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 Corporate OfficerLLC Manager Jan 20, 2010
Corporate DirectorLLC Manager 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": "1677801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1629778147",
    "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": "345 BUCK KIRKLAND RD.",
            "city": "POPLARVILLE",
            "state": "MS",
            "postal_code": "39470",
            "telephone_number": "985-646-1580",
            "fax_number": "888-863-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S INTERNATIONAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-03",
        "last_updated": "2023-03-03",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "ZIERHUT",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAL STAFF AFFAIRS",
        "authorized_official_telephone_number": "985-646-1580"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's International Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplarville, MS

Sources for this page

Verify at the official NPI Registry.