NPIMap

Organization Active NPI

Children's International, LLC

Doing business as Children's International Medical Group

  • Rural Health Clinic/Center
  • Gautier, MS
National Provider Identifier
1720775265
Registry record updated Apr 24, 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
341 US 90
Ste a
Gautier, MS 39553
Phone
(228) 400-0098
Fax
(833) 518-1886
NPI assigned
Apr 24, 2023
Last updated
Apr 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Authorized official

Name
Mrs. 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

341 US 90
Ste a
Gautier, MS 39553

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
O20230623000077 MS Part A Provider - Rural Health Clinic 1254633308 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gautier, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720775265. Details of each certification follow.

Rural health clinic certification: CCN A53835

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
341 US-90
Suite a
Gautier, MS 39553

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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 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 LLC, Medical provider/supplier, For-profit 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%

NPI Registry JSON

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

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1720775265",
    "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": "341 US 90",
            "address_2": "STE A",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "39553",
            "telephone_number": "228-400-0098",
            "fax_number": "833-518-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S INTERNATIONAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-17",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "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 Gautier, MS

Sources for this page

Verify at the official NPI Registry.