NPIMap

Organization Active NPI

Fast Pace Kentucky, PLLC

  • Rural Health Clinic/Center
  • Mt Washington, KY
National Provider Identifier
1265145452
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE KENTUCKY, PLLC
Practice address
145 Brookeway Dr
Mount Washington, KY 40047-5576
Phone
(502) 538-2430
NPI assigned
Jan 3, 2023
Last updated
Jan 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 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 NU Primary

Addresses

Primary practice location

145 Brookeway Dr
Mount Washington, KY 40047-5576

Mailing address

PO Box 306414
Nashville, TN 37230-6414
Phone (931) 253-1110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220715000507 KY Part A Provider - Rural Health Clinic 0143525998 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Washington, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265145452. Details of each certification follow.

Rural health clinic certification: CCN B03896

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 8, 2022
Last certification
Aug 8, 2022
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Oct 5, 2009 in KY
Enrollment address
145 Brookeway Dr
Mount Washington, KY 40047-5576

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
Tax ID family
Fast Pace Kentucky PLLC44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

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
Barry Louis Taylor Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 33.33%
Sydni Clemmons Individual W-2 Managing EmployeeDirector of Credentialing May 31, 2022
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership Interest Oct 5, 2019 34%
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.

NPI Registry JSON

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1265145452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306414",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306414",
            "telephone_number": "931-253-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 BROOKEWAY DR",
            "city": "MOUNT WASHINGTON",
            "state": "KY",
            "postal_code": "400475576",
            "telephone_number": "502-538-2430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Washington, KY

Sources for this page

Verify at the official NPI Registry.