Active NPI
Ellesse Smith
- Nurse Practitioner
- Old Hickory, TN
National Provider Identifier
1275292666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 30474
- Practice address
- 1250 Robinson Rd
Old Hickory, TN 37138-3326 - Phone
- (615) 390-4733
- NPI assigned
- Dec 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 30474 | TN | Primary |
Addresses
Primary practice location
1250 Robinson Rd
Old Hickory, TN 37138-3326
Mailing address
808 Walpole Dr
Gallatin, TN 37066-6753
Phone (615) 390-4733
Other names 1
- Ellesse Kidd
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1250 Robinson Rd
Old Hickory, TN 37138-3326
Phone (615) 390-6775
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Services of Middle Tennessee, LLC | Current | Accepting new patients | |
| Patient Care LLC | Past | Accepting new patients |
Locations
1250 Robinson Rd
Old Hickory, TN 37138
Phone (615) 390-6775
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.
-
- Internal Medicine Physician
- Nashville, TN
- NPI 1922331842
-
- Internal Medicine Physician
- Antioch, TN
- NPI 1669975223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639353600000",
"number": "1275292666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 WALPOLE DR",
"city": "GALLATIN",
"state": "TN",
"postal_code": "370666753",
"telephone_number": "615-390-4733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 ROBINSON RD",
"city": "OLD HICKORY",
"state": "TN",
"postal_code": "371383326",
"telephone_number": "615-390-4733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "ELLESSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-13",
"last_updated": "2021-12-13",
"certification_date": "2021-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TN",
"license": "30474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELLESSE",
"last_name": "KIDD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Old Hickory, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.