HYDE PARK MEDICAL
NPI 1043903990
Family Medicine in Smyrna, TN
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
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Hyde Park Medical is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Hyde Park Medical, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, TNFrequently 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.
Is Hyde Park Medical Group, PLLC enrolled in Medicare?
Yes. Hyde Park Medical Group, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Hyde Park Medical Group, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Hyde Park Medical Group, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 2 years 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.
# Hyde Park Medical · NPI 1043903990
Family Medicine organization in Smyrna, Tennessee. Organization record, active in the CMS NPPES registry since May 29, 2023.
## Identity
- **NPI:** 1043903990 (Entity type: Organization)
- **Enumerated:** May 29, 2023
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Hyde Park Medical Group, Pllc
- **Organization subpart:** No
- **Authorized official:** Khaisha Gist, MEDICAL DIRECTOR
## Practice location
- **Address:** 741 PRESIDENT PL STE 140, Smyrna, TN 37167-6808
- **Phone:** (615) 412-8662
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 1, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1043903990) · Data from the CMS NPPES public registry.