Active NPI
Jessica Hysmith, MD
- Pediatrics Physician
- Memphis, TN
National Provider Identifier
1659699247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD0000049914
- Practice address
- 1129 Hale Rd
Memphis, TN 38116-6373 - Phone
- (901) 396-0390
- Fax
- (901) 396-3728
- NPI assigned
- May 7, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | MD0000049914 | TN | Primary |
Addresses
Primary practice location
1129 Hale Rd
Memphis, TN 38116-6373
Mailing address
1129 Hale Rd
Memphis, TN 38116-6373
Phone (901) 396-0390
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130515000418 | TN | Order and Referring Only - Pediatric Medicine | 0042457830 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000049914 | TN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memphis Children'S Clinic, PLLC | Pediatrics | Past | Accepting new patients |
| Memphis Children'S Clinic, PLLC | Pediatrics | Past | Accepting new patients |
| Memphis Children'S Clinic,PLLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- jhysmith27265@mlh.direct-ci.com
- jhysmith@linux.pcc-direct.com
Organizations & group practices 3
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372032000000",
"number": "1659699247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1129 HALE RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381166373",
"telephone_number": "901-396-0390",
"fax_number": "901-396-3728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1129 HALE RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381166373",
"telephone_number": "901-396-0390",
"fax_number": "901-396-3728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HYSMITH",
"first_name": "JESSICA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-07",
"last_updated": "2013-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "MD0000049914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.