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HYDE PARK MEDICAL
NPI 1043903990
Family Medicine in Smyrna, TN

Active since May 29, 2023CLIA 44D2287936 · Waiver
741 PRESIDENT PL STE 140, SMYRNA, TN 37167(615) 412-8662 Get Directions Write a Review

NPPES record last updated: November 1, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 23, 2023, May 29, 2023 (2 updates tracked since 2023).

About Hyde Park Medical NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HYDE PARK MEDICAL (NPI 1043903990) is a healthcare organization registered as a family medicine in Smyrna, Tennessee and active in the NPI registry since May 2023. The organization holds a CLIA Waiver certificate valid through August 17, 2027 and lists Khaisha Gist, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1043903990
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameHYDE PARK MEDICAL GROUP, PLLC
Location Address741 PRESIDENT PL STE 140Smyrna, TN 37167-6808
Mailing AddressPo Box 23Gladeville, TN 37071-0023
Phone(615) 412-8662
Organization SubpartNo
Authorized OfficialKhaisha GistMedical Director · (773) 802-2723
Enumeration DateMay 29, 2023
Last NPPES UpdateNovember 1, 20242 updates tracked since enumeration
NPPES CertifiedNovember 1, 2024
✔ NPI 1043903990 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
741 PRESIDENT PL STE 140, Smyrna, TN 37167
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Other Names 1

Doing Business AsHyde Park Medical

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2287936

Hyde Park Medical Group, PLLC Dba Hyde Park Medical · Smyrna, TN
Active · expires Aug 17, 2027
CLIA Number44D2287936
Laboratory TypePhysician Office
Certificate Effective DateAugust 18, 2025
Certificate Expiration DateAugust 17, 2027
Laboratory DirectorKhaisha Gist
Laboratory Phone(615) 412-8662
Laboratory LocationHyde Park Medical Group, PLLC Dba Hyde Park Medical741 Presidents Place, Suite 140, Smyrna, TN 37167
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HARPETH VALLEY DERMATOLOGY PLLC
Dermatology
741 PRESIDENT PL STE 140
SMYRNA, TN 37167
Rutherford County (615) 900-0204

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Hyde Park Medical Group, PLLC's NPI number?

The NPI number for Hyde Park Medical Group, PLLC is 1043903990. It was assigned to this organization in the NPPES registry on May 29, 2023. The provider is doing business as Hyde Park Medical.

Where is Hyde Park Medical Group, PLLC located?

Hyde Park Medical Group, PLLC is located at 741 President Pl Ste 140, Smyrna, TN 37167. The listed phone number is (615) 412-8662.

What is Hyde Park Medical Group, PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Hyde Park Medical Group, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2287936) is associated with this NPI, valid through August 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Hyde Park Medical Group, PLLC was last updated on November 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.