NPIMap

Organization Active NPI

Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Sylacauga, AL
National Provider Identifier
1043975402
Registry record updated Oct 28, 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
41357 US Highway 280
Suite B
Sylacauga, AL 35150-8046
Phone
(312) 531-1109
Fax
(317) 229-9199
NPI assigned
Nov 1, 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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2271334Fast Pace Medical Clinic, PLLC41375 US Highway 280, Sylacauga, AL 35150Certificate of waiverOct 31, 2026

Medicare participation

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

Rural health clinic certification: CCN 883868

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
Jan 21, 2022
Last certification
Jan 21, 2022
Ownership / control type
1A
Organization structure
OtherProprietary
Incorporated
Oct 5, 2009 in TN
Enrollment address
104 1St Ave S
Collinwood, TN 38450-6614

Rural health clinic certification: CCN 018963

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
Mar 22, 2023
Last certification
Mar 22, 2023
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Oct 5, 2009 in TN
Enrollment address
41375 US Highway 280
Ste B
Sylacauga, AL 35150-8046

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 11, 2021
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership Interest Oct 5, 2021 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

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20211124000277 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: Collinwood, TN
O20221205003290 AL Part a Provider - Rural Health Clinic 5395881841 Practice locations: Sylacauga, AL

National Provider Directory

National Provider Directory

Locations

3 N Manatee St
Brazil, IN 47834
Phone (812) 531-1127

1764 E State Road 163
Clinton, IN 47842
Phone (765) 820-2120

1732 W North St
Kendallville, IN 46755
Phone (260) 544-8054

1321 Huntsville Hwy
Fayetteville, TN 37334
Phone (931) 297-2201

2634 N Central Ave
Humboldt, TN 38343
Phone (731) 324-1526

502 Ellington Dr
Lafayette, TN 37083
Phone (615) 561-1042

125 W Church St
Lexington, TN 38351
Phone (731) 249-9300

910 New Highway 68
Sweetwater, TN 37874
Phone (423) 836-9304

1705 W Reelfoot Ave
Union City, TN 38261
Phone (731) 599-1102

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

41357 US Highway 280
Suite B
Sylacauga, AL 35150-8046

Mailing address

PO Box 306244
Nashville, TN 37230-6244

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 28, 2022.

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1043975402",
    "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": "41357 US HIGHWAY 280",
            "address_2": "SUITE B",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "351508046",
            "telephone_number": "312-531-1109",
            "fax_number": "317-229-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-01",
        "last_updated": "2022-10-28",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylacauga, AL

Sources for this page

Verify at the official NPI Registry.