NPIMap

Children'S International, LLC

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

NPI 1629778147 · NPPES record last updated Mar 3, 2023

Key facts

NPI
1629778147
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
CHILDREN'S INTERNATIONAL, LLC
Practice address
345 Buck Kirkland Rd.
Poplarville, MS 39470
Phone
(985) 646-1580
Fax
(888) 863-4274
NPI assigned
Mar 3, 2023
Organization subpart
No

Authorized official

Name
Lindsey Zierhut
Title
Director of Medical Staff Affairs
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
25D2277739Children'S International Medical Group
345 Buck Kirkland Rd, Poplarville, MS 39470		Certificate of waiverMar 2, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

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
LLC · Proprietary
Incorporated
Apr 13, 1993 in LA
Enrollment address
345 Buck Kirkland Rd
Poplarville, MS 39470-3215

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 Officer
Manager of Living Trust		 Jan 20, 2010 50%
Corporate Director
Manager of Living Trust		 Jan 20, 2010 50%
Lacey Shaw
Individual 		W-2 Managing Employee
Chief Operating Officer		 Jul 6, 2010
Brittany Frost
Individual 		W-2 Managing Employee
Chief 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 Officer
LLC Manager		 Jan 20, 2010
Corporate Director
LLC 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 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
O20230508002676 MS Part a Provider - Rural Health Clinic 1254633308 Practice locations: Poplarville, MS

National Provider Directory

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

Locations

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

Specialties & licenses

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

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

  • Children's International Medical Group Doing business as

Other providers in Poplarville, MS

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

Sources for this page

Verify at the official NPI Registry.