NPIMap

Organization Active NPI

Fast Pace Medical Clinic PLLC

  • Urgent Care Clinic/Center
  • Lincoln, AL
National Provider Identifier
1023773322
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
FAST PACE MEDICAL CLINIC PLLC
Practice address
25 Bear Pkwy
Lincoln, AL 35096-6798
Phone
(205) 548-4106
NPI assigned
Nov 2, 2021
Last updated
Oct 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Benson
Title
Coo
Phone
(931) 253-1110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

25 Bear Pkwy
Lincoln, AL 35096-6798

Mailing address

PO Box 306244
Nashville, TN 37230-6244

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211130000868 TN Part A Provider - Rural Health Clinic 5395881841 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Smithville, TN
O20221109001483 AL Part B Supplier - Clinic/Group Practice 5395881841 Receives reassigned benefits from 1 practitioner
Practice locations: Alabaster, AL; Hueytown, AL; Lincoln, AL; Sylacauga, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023773322. Details of each certification follow.

Rural health clinic certification: CCN 883908

Legal name
FAST PACE MEDICAL CLINIC PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 2022
Last certification
Feb 1, 2022
Ownership / control type
1A
Organization structure
OtherProprietary
Incorporated
Oct 5, 2009 in TN
Enrollment address
101 W Broad St
Smithville, TN 37166-1915

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Selena Michelle Gurley Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%
Fpmcm, LLC Organization, Franklin, TN LLC Operational/Managerial Control Oct 5, 2009 100%
Sydni Clemmons Individual Corporate DirectorDirector of Credentilailng Nov 1, 2021
W-2 Managing Employee Nov 1, 2021
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1023773322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306244",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 BEAR PKWY",
            "city": "LINCOLN",
            "state": "AL",
            "postal_code": "350966798",
            "telephone_number": "205-548-4106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "931-253-1110"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, AL

Sources for this page

Verify at the official NPI Registry.