Main Street Health, a health care company based in Nashville, is the No. 1 fastest-growing private American company in the nation, according to Inc. Magazine.
Dozens more companies in Middle Tennessee and throughout the state are expected to make the list of 5,000 U.S. companies with rapid growth when the New York City-based magazine releases the annual Inc. 5000 list on Aug. 11.
More than 100 Tennessee businesses ranked among the fastest-growing private companies last year, according to Inc. Magazine.
Bennett Graham, president of Main Street Health, received advanced notice from the magazine of the company's No. 1 ranking. Main Street started in 2021 and is now the nation's largest provider of value-based care focused on rural America.
"Our mission
is to bring better access to rural health care in regard to high quality care," said Bennett Graham, president of Main Street Health.
The company teams with primary care physicians to focus on preventative care. Main Street hires, trains and pays navigators to coordinate with rural physicians to answer patients' questions, and to encourage patients to make regular preventative health visits and take medicines as prescribed. The navigators also work with patients to find solutions to barriers, such as costs and transportation.
The company now has more than 3,800 providers across 25 states, serving nearly four million rural Americans.
In its five-year history, Main Street Health has shown a 53% reduction in hospital readmissions and an 11% reduction in medical costs.
Inc., billed as "the voice of the American entrepreneur," decides who makes the list and at what ranking based on the company's percentage revenue growth over the last three years.
Main Street Health's revenue grew from about $700,000 in 2022 to more than $3.8 billion in 2025, according to the company data provided to Inc. Magazine.
Entrepreneur Brad Smith, who gained the national spotlight as a Trump administration health policy adviser, founded Main Street Health in 2021. By the end of 2025, the company had 730 employees.
"Whether it was spending time with my grandmom in Spring City in the summers, driving Sen. Bob Corker to all 95 counties across Tennessee, or taking my kids to visit their granddad's farm in South Alabama, rural America has always been a part of my life," Smith said in a statement. "While I have seen the best of rural America, I have also seen the tremendous unmet health care need."
Graham grew up spending time on his grandmother's farm in Trousdale County, about 50 miles northeast of Nashville. He said the area hospital was one-story and had dedicated physicians but not the specialists you find at major medical systems in Nashville and other urban areas.
Both men realized there were health care deserts across Tennessee and beyond, and then brainstormed ways to help.
Smith stepped down as the CEO and chairman of Main Street Health in January 2025 to become a health advisor for the Trump administration. He spent four months as an unpaid adviser to the Department of Government Efficiency, known as DOGE, with Elon Musk. Starting in the summer of 2025, he began serving as a senior adviser to the State Department, working with Secretary of State Marco Rubio to reestablish America's health foreign assistance program.
"There's 700 different IT systems today at NIH," Smith said, according to the White House website, stressing the importance of enhancing health care through changes at the National Institutes of Health.
"They can't speak to each other."
He said to make great medical discoveries, "you have to connect the data."
Several major hospitals in Nashville use different electronic medical record systems. Main Street Health created its own system to be able to provide more information to its navigators and partner physicians, Graham said.
Venture capitalist Annie Lamont, whose husband, Ned Lamont, is the governor of Connecticut, said she was impressed by Smith and his mission to improve rural health care.
"Brad is certainly in the top 1% of entrepreneurs I've backed," Connecticut's first lady said.
"He just accesses problems incredibly fast, and he's very focused at problem sovlving."
In 2023, Smith had another company that earned the No. 1 spot on the Inc. 5000 list of fastest-growing businesses, CareBridge. Smith teamed with former U.S. Sen. Bill Frist to create the company, which aimed to rein in costs and deliver better care to Americans on Medicaid and Medicare.
How many Nashville area businesses made the Inc. 5000 list in 2025?
The Inc. 5000 list in 2025 included 84 businesses located in the Nashville metro area.
Among the 132 fastest-growing private companies in Tennessee, the median growth was 182%. In total, the businesses have added 15,267 jobs to the state's economy in the last three years, according to Inc.
Only three Tennessee companies landed in the top 300 last year, and they are all categorized in the health services industry.
What other Nashville area companies made the fastest-growing list?
Inc. Magazine began by listing the top growing 500 businesses in 1982 but expanded the rankings 25 years later to 5,000 to provide "a deeper understanding of the entrepreneurial landscape," according to its website.
The names of the companies who made the list of 5,000 is scheduled to be released early Aug. 11. Names of other Nashville area businesses who made the cut will be listed in an article by The Tennessean.
Beth Warren covers health care and can be reached at bwarren@tennessean.com or on X at @BethWarrenCJ.
This article originally appeared on Nashville Tennessean: Tennessee health care company named fastest-growing in the U.S.: report
