NPIMap

Organization Active NPI

Fast Pace Medical Clinic PLLC

Doing business as Fast Pace Health

  • Rural Health Clinic/Center
  • Jackson, AL
National Provider Identifier
1033890132
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE MEDICAL CLINIC PLLC
Doing business as
Fast Pace Health
Practice address
4005 N College Ave
Jackson, AL 36545-2024
Phone
(251) 744-6084
NPI assigned
Jul 31, 2023
Last updated
Aug 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Authorized official

Name
Sydni Clemmons
Title
Credentialing Manager
Phone
(901) 351-1791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

4005 N College Ave
Jackson, AL 36545-2024

Mailing address

PO Box 306491
Nashville, TN 37230-6491
Phone (931) 253-1110

Other names 1

  • Fast Pace Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230810002775 AL Part A Provider - Rural Health Clinic 5395881841 Practice locations: Jackson, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033890132. Details of each certification follow.

Rural health clinic certification: CCN 018967

Legal name
FAST PACE MEDICAL CLINIC PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2023
Last certification
Dec 21, 2023
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Oct 5, 2009 in TN
Enrollment address
4005 N College Ave
Jackson, AL 36545-2024

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

National Provider Directory

National Provider Directory
Tax ID family
Fast Pace Medical Clinic PLLC133 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Ownership & related parties

All disclosed owners & managing parties 4

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 InterestOwner Oct 5, 2019 33.33%
Sydni Clemmons Individual W-2 Managing EmployeeDirector of Credentialing Sep 15, 2023
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership InterestOwner Oct 5, 2019 33.33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership InterestOwner 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.

NPI Registry JSON

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1033890132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306491",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306491",
            "telephone_number": "931-253-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 N COLLEGE AVE",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452024",
            "telephone_number": "251-744-6084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SYDNI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "901-351-1791"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fast Pace Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fast Pace Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, AL

Sources for this page

Verify at the official NPI Registry.