Active NPI
Hyde Park Medical Group, PLLC
Doing business as Hyde Park Medical
- Family Medicine Physician
- Smyrna, TN
National Provider Identifier
1043903990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- HYDE PARK MEDICAL GROUP, PLLC
- Doing business as
- Hyde Park Medical
- Practice address
- 741 President PL Ste 140
Smyrna, TN 37167-6808 - Phone
- (615) 412-8662
- NPI assigned
- May 29, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Khaisha Gist, MD
- Title
- Medical Director
- Phone
- (773) 802-2723
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
741 President PL Ste 140
Smyrna, TN 37167-6808
Mailing address
PO Box 23
Gladeville, TN 37071-0023
Other names 1
- Hyde Park Medical
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Hyde Park Medical
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Nashville, TN
- NPI 1598455123
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685318400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1730419200000",
"number": "1043903990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 23",
"city": "GLADEVILLE",
"state": "TN",
"postal_code": "370710023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "741 PRESIDENT PL STE 140",
"city": "SMYRNA",
"state": "TN",
"postal_code": "371676808",
"telephone_number": "615-412-8662"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HYDE PARK MEDICAL GROUP, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-05-29",
"last_updated": "2024-11-01",
"certification_date": "2024-11-01",
"status": "A",
"authorized_official_last_name": "GIST",
"authorized_official_first_name": "KHAISHA",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "773-802-2723",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Hyde Park Medical",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Hyde Park Medical",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Smyrna, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.