Fast Pace Medical Clinic PLLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FAST PACE MEDICAL CLINIC PLLC

Practice address

1414 W College St
Pulaski, TN 38478-5202

Phone

(931) 363-3004

Fax

(931) 363-6004

NPI assigned

Nov 2, 2021

Organization subpart

No

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

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Rural health clinic certification: CCN 883879

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

562 W Main St
Cookeville, TN 38506-5382

Other NPIs on the same Medicare enrollment 1

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

• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774

  O20211129000874

  Same enrollment

Locations

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.

Owners & managing parties with NPI records 3

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

• Karen Denise Daingerfield, FNP

  • Family Nurse Practitioner
  • McMinnville, TN
  • NPI 1538594494

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Dana Kay Martin, C.F.N.P.

  • Family Nurse Practitioner
  • Selmer, TN
  • NPI 1497781454

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Selena Michelle Gurley, CRNP

  • Family Nurse Practitioner
  • Florence, AL
  • NPI 1215214432

  5% Or Greater Direct Ownership Interest

  CMS ownership

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1063177368",
    "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": "1414 W COLLEGE ST",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384785202",
            "telephone_number": "931-363-3004",
            "fax_number": "931-363-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "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": "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": []
}

• Gregory Guy Dugger
• Taylor Jenkins Dunnavant, DPT
• Hayley Ann Evans, M.S.
• F. Vincent, PLLC
• Alfred Judson Farrier, DC
• Fast Pace Medical Clinic PLLC
• Ferdinand & Eresvita Balatico MD PC
• Augustus William Fischer, DDS
• Brandon Matt Fleming, DPT
• Armando Cabot Foronda, M.D.

• Rural Health Clinic/Center in Pulaski, TN
• Providers in Pulaski, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.