Eliezer Hernandez MD P.a.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

J6834 Issued in TX

Legal business name

ELIEZER HERNANDEZ MD P.A.

Practice address

1975 N Veterans Blvd
Ste. 5
Eagle Pass, TX 78852-4456

Phone

(830) 773-9449

Fax

(830) 757-3142

NPI assigned

Apr 26, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Eliezer Hernandez, M.D.,P.A.NPI 1033217245

Title

Owner

Phone

(830) 773-9449

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Yeled Shalom Pediatric Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 458987

Legal name

ELIEZER HERNANDEZ MD PA

Doing business as

YELED SHALOM PEDIATRIC CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 23, 1998

Last certification

Nov 1, 2022

Ownership / control type

1B

Most recent change of ownership

Oct 18, 2000 (1 total)

Organization structure

OtherProprietary

Incorporated

Feb 1, 2002 in TX

Enrollment address

1975 N Veterans Blvd
Ste 5
Eagle Pass, TX 78852-4456

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Eliezer Hernandez, M.D.

  • Preferred Provider Organization
  • Eagle Pass, TX
  • NPI 1033217245

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eliezer Hernandez, M.D.

  • Preferred Provider Organization
  • Eagle Pass, TX
  • NPI 1033217245
  Medicare reassignment NPD Authorized official
• Carlos Alberto Flores Oria, MD

  • Pediatric Pulmonology Physician
  • San Antonio, TX
  • NPI 1154705762
  Medicare reassignment NPD
• Eduardo Jose Quintanilla Jerez, MD

  • Pediatrics Physician
  • Eagle Pass, TX
  • NPI 1164040358
  Medicare reassignment NPD
• Karla Barrera, PA-C

  • Medical Physician Assistant
  • Laredo, TX
  • NPI 1114466448
  NPD (past)
• Maria Emilia Tellez, MD

  • Pediatrics Physician
  • Houston, TX
  • NPI 1053316471
  NPD (past)
• Guillermo Augusto Urueta, MD

  • Pediatrics Physician
  • Eagle Pass, TX
  • NPI 1437127479
  NPD (past)

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1770540684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1145",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788531145",
            "telephone_number": "830-773-9449",
            "fax_number": "830-757-3142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 N VETERANS BLVD",
            "address_2": "STE. 5",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788524456",
            "telephone_number": "830-773-9449",
            "fax_number": "830-757-3142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIEZER HERNANDEZ MD P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "ELIEZER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-773-9449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,P.A."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "J6834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063670601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153805002",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153805001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yeled Shalom Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eagle Pass Spine and Rehab,LLC
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• Samantha G Edwin, PA-C
• El Paso del Aguila Anesthesia Associates PLLC
• Elite Pediatrics PLLC
• Emergency Physicians of Eagle Pass, PLLC
• En Familia
• Endeavor Home Care LLC
• Alejandro Esquivel Jr.

• Rural Health Clinic/Center in Eagle Pass, TX
• Providers in Eagle Pass, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.