Individual provider Active NPI

Obed Hernandez

  • Family Nurse Practitioner
  • Clinton, MS
National Provider Identifier
1831965268
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
906368 Issued in MS
Practice address
8080 Clinton Tinnin Rd
Clinton, MS 39056-9461
Phone
(769) 257-2706
NPI assigned
Nov 27, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 906368 MS Primary

Addresses

Primary practice location

8080 Clinton Tinnin Rd
Clinton, MS 39056-9461

Mailing address

8080 Clinton Tinnin Rd
Clinton, MS 39056-9461

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240411001932 MS Practitioner - Nurse Practitioner 5294174199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775

Hospital & facility affiliations

  • University of Mississippi Med Center Hospital, Jackson, MS, CCN 250001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
906368MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 30, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 30, 2024 Accepting new patients

Locations

504 Clinton Center Dr
Ste 4300
Clinton, MS 39056

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

1410 E Woodrow Wilson Ave
Jackson, MS 39216
Phone (601) 815-4775

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1831965268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 CLINTON TINNIN RD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390569461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8080 CLINTON TINNIN RD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390569461",
            "telephone_number": "769-257-2706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "OBED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "906368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MS

Sources for this page

Verify at the official NPI Registry.