NPIMap

Organization Active NPI

Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Lincoln, AL
National Provider Identifier
1043975345
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE MEDICAL CLINIC PLLC
Practice address
25 Bear Pkwy
Lincoln, AL 35096-6798
Phone
(205) 548-4106
Fax
(931) 722-9919
NPI assigned
Nov 2, 2021
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 1

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

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

Practitioners 736

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 736

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211130001768 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: Selmer, TN
O20221121003331 AL Part a Provider - Rural Health Clinic 5395881841 Practice locations: Lincoln, AL

Rural health clinic certification: CCN 883881

Medicare enrollment files
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
854 Mulberry Ave
Selmer, TN 38375-2334

Rural health clinic certification: CCN 018962

Medicare enrollment files
Legal name
FAST PACE MEDICAL CLINIC PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 6, 2023
Last certification
Apr 6, 2023
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Oct 5, 2009 in TN
Enrollment address
25 Bear Pkwy
Lincoln, AL 35096-6798

All disclosed owners & managing parties 7

Medicare enrollment files

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%
5% Or Greater Direct Ownership InterestOwner Oct 5, 2019 33.33%
Fpmcm, LLC Organization, Franklin, TN LLC Operational/Managerial Control Oct 5, 2009 100%
Sydni Clemmons Individual Corporate DirectorDirector of Credentialing 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%
5% Or Greater Direct Ownership InterestOwner Oct 5, 2019 33.33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%
5% Or Greater Direct Ownership InterestOwner Oct 5, 2019 33.33%
Melissa Harlan Individual W-2 Managing EmployeeDelegated Official Jan 1, 2024
Christy Littlejohn Individual W-2 Managing EmployeeDelegated Official Jan 1, 2024

National Provider Directory

National Provider Directory

Locations

854 Mulberry Ave
Selmer, TN 38375
Phone (731) 646-1781

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

25 Bear Pkwy
Lincoln, AL 35096-6798

Mailing address

PO Box 306244
Nashville, TN 37230-6244

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1515574MedicaidTN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 25, 2022.

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1043975345",
    "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",
            "fax_number": "931-722-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1515574",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, AL

Sources for this page

Verify at the official NPI Registry.