Active NPI
Fast Pace Mississippi, PLLC
- Rural Health Clinic/Center
- Ripley, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- FAST PACE MISSISSIPPI, PLLC
- Practice address
- 517 City Ave S
Ripley, MS 38663 - Phone
- (662) 587-8206
- Fax
- (662) 587-8207
- NPI assigned
- Sep 21, 2017
- Organization subpart
- No
NPPES NPI Registry
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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Primary | ||
| Nurse Practitioner | 363L00000X | |||
| Family Nurse Practitioner | 363LF0000X |
Addresses
Primary practice location
517 City Ave S
Ripley, MS 38663
Mailing address
6550 Carothers Pkwy Ste 225
Franklin, TN 37067-6662
Phone (931) 253-1110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07277821 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180111000291 | MS | Part B Supplier - Clinic/Group Practice | 3678832029 |
Receives reassigned benefits from 458 practitioners Practice locations: Ripley, MS; Magee, MS; McComb, MS; Meridian, MS; Natchez, MS; Newton, MS; Olive Branch, MS; Philadelphia, MS… |
| O20211217001505 | MS | Part A Provider - Rural Health Clinic | 3678832029 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ripley, MS |
Rural health clinic certification: CCN A53819
- Legal name
- FAST PACE MISSISSIPPI 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
- 1B
- Organization structure
- Other
- Incorporated
- Sep 5, 2017 in MS
- Enrollment address
- 517 City Ave S
Ripley, MS 38663-2517
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
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 DirectoryLocations
1621 W Peace St
Canton, MS 39046
Phone (601) 391-2716
115 Highway 16 W
Carthage, MS 39051
Phone (601) 298-3101
1400 Highway 72 E
Corinth, MS 38834
Phone (662) 664-5537
2009 Highway 82 W
Greenwood, MS 38930
Phone (662) 595-4601
700 Sunset Dr
Grenada, MS 38901
Phone (662) 307-2884
533 Lake St
Hazlehurst, MS 39083
Phone (601) 533-5253
602 Craft St
Holly Springs, MS 38635
Phone (662) 333-8070
616 Highway 82 W
Indianola, MS 38751
Phone (662) 635-8680
1017 W Beacon St
Philadelphia, MS 39350
Phone (769) 200-0730
517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206
1161 Church Rd W
Southaven, MS 38671
Phone (662) 253-1067
1195 Church Rd W
Southaven, MS 38671
Phone (662) 253-1067
934 S Gloster St
Tupelo, MS 38801
Phone (623) 465-9466
451 Highway 90
Waveland, MS 39576
Phone (228) 400-0055
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Sydni Clemmons | Corporate Director | Dec 10, 2021 | |
| W-2 Managing Employee | Dec 10, 2021 | ||
| Dana Kay Martin | 5% Or Greater Direct Ownership Interest | May 1, 2019 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Nurse Practitioner
- Selmer, TN
- NPI 1497781454
5% Or Greater Direct Ownership Interest
Practitioners & affiliated clinicians
Practitioners 496
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- Diamondhead, MS
- NPI 1669745303
MS, Nurse Practitioner
-
- Family Nurse Practitioner
- Philadelphia, MS
- NPI 1548941669
Family, MS
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505952000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1634256000000",
"number": "1447769559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6550 CAROTHERS PKWY STE 225",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370676662",
"telephone_number": "931-253-1110",
"fax_number": "931-253-1110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "517 CITY AVE S",
"city": "RIPLEY",
"state": "MS",
"postal_code": "38663",
"telephone_number": "662-587-8206",
"fax_number": "662-587-8207"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAST PACE MISSISSIPPI, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-09-21",
"last_updated": "2021-10-15",
"certification_date": "2021-10-15",
"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": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07277821",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ripley, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.